Alia Crum

All Publications

• White patients' physical responses to healthcare treatments are influenced by provider race and gender. Proceedings of the National Academy of Sciences of the United States of America Howe, L. C., Hardebeck, E. J., Eberhardt, J. L., Markus, H. R., Crum, A. J. 2022; 119 (27): e2007717119

  Abstract

  The healthcare workforce in the United States is becoming increasingly diverse, gradually shifting society away from the historical overrepresentation of White men among physicians. However, given the long-standing underrepresentation of people of color and women in the medical field, patients may still associate the concept of doctors with White men and may be physiologically less responsive to treatment administered by providers from other backgrounds. To investigate this, we varied the race and gender of the provider from which White patients received identical treatment for allergic reactions and measured patients' improvement in response to this treatment, thus isolating how a provider's demographic characteristics shape physical responses to healthcare. A total of 187 White patients experiencing a laboratory-induced allergic reaction interacted with a healthcare provider who applied a treatment cream and told them it would relieve their allergic reaction. Unbeknownst to the patients, the cream was inert (an unscented lotion) and interactions were completely standardized except for the provider's race and gender. Patients were randomly assigned to interact with a provider who was a man or a woman and Asian, Black, or White. A fully blinded research assistant measured the change in the size of patients' allergic reaction after cream administration. Results indicated that White patients showed a weaker response to the standardized treatment over time when it was administered by women or Black providers. We explore several potential explanations for these varied physiological treatment responses and discuss the implications of problematic race and gender dynamics that can endure "under the skin," even for those who aim to be bias free.

  View details for DOI 10.1073/pnas.2007717119

  View details for PubMedID 35749352

• Negative consequences of self-presentation on disclosure of health information: A catch-22 for Black patients? Social science & medicine (1982) Louis, K., Crum, A. J., Markus, H. R. 2022: 115141

  Abstract

  RATIONALE: Most patients assume that it is adaptive to present oneself in a positive light when interacting with medical professionals. Here in two studies focused on Black patients we ask: might this desire to present oneself well inhibit the disclosure of health-relevant information when patients are concerned about negative and stereotypic evaluations by their health care providers?OBJECTIVE: Specifically, we explore three important questions: First, whether self-presentational efforts (e.g., working hard to sound knowledgeable or "smart") are negatively associated with disclosure of health information (e.g., not taking certain medications); Second, whether patient-provider racial congruence (e.g. Black patients interacting with a Black vs. a White doctor) moderates that relationship; and third, more broadly, what factors promote or inhibit disclosure of health information for Black patients in medical interactions.METHODS: These questions were investigated using mixed methodology (survey, experimental, qualitative) studies on CloudResearch and Prolific.RESULTS: We found a potential catch-22: participants who spend more effort self-presenting tend to be less comfortable disclosing health information to their healthcare providers. Moreover, Study 1 (N=321) indicated that the negative relationship between self-presentation and disclosure was significant in Black-incongruent (i.e., Black patient and White provider) and White-congruent (i.e., White patient and White provider) medical interactions. Study 2 (N=361) did not find a significant moderation by race of the provider but instead suggested that the relationship between self-presentation and disclosure was moderated by expectations of unfair treatment. Exploratory qualitative analyses suggested that some Black participants face a dilemma when deciding whether to disclose information to their healthcare providers. They weigh the kind of information they will share, and how sharing some information might lead to embarrassment and judgment.CONCLUSION: Mitigating the potentially counteractive effects of self-presentation on disclosure and working to foster contexts that encourage honest disclosure of health information may help to reduce health care inequalities.

  View details for DOI 10.1016/j.socscimed.2022.115141

  View details for PubMedID 35778285

• Mindset is associated with future physical activity and management strategies in individuals with knee osteoarthritis. Annals of physical and rehabilitation medicine Boswell, M. A., Evans, K. M., Zion, S. R., Boles, D. Z., Hicks, J. L., Delp, S. L., Crum, A. J. 2022; 65 (6): 101634

  Abstract

  Despite the benefits of physical activity for individuals with knee osteoarthritis (KOA), physical activity levels are low in this population.We conducted a repeated cross-sectional study to compare mindset about physical activity among individuals with and without KOA and to investigate whether mindset relates to physical activity.Participants with (n = 150) and without (n = 152) KOA completed an online survey at enrollment (T1). Participants with KOA repeated the survey 3 weeks later (T2; n = 62). The mindset questionnaire, scored from 1 to 4, assessed the extent to which individuals associate the process of exercising with less appeal-focused qualities (e.g., boring, painful, isolating, and depriving) versus appeal-focused (e.g., fun, pleasurable, social, and indulgent). Using linear regression, we examined the relationship between mindset and having KOA, and, in the subgroup of KOA participants, the relationship between mindset at T1 and self-reported physical activity at T2. We also compared mindset between people who use medication for management and those who use exercise.Within the KOA group, a more appeal-focused mindset was associated with higher future physical activity (β=38.72, p = 0.006) when controlling for demographics, health, and KOA symptoms. Individuals who used exercise with or without pain medication or injections had a more appeal-focused mindset than those who used medication or injections without exercise (p<0.001). A less appeal-focused mindset regarding physical activity was not significantly associated with KOA (β = -0.14, p = 0.067). Further, the mindset score demonstrated strong internal consistency (α = 0.92; T1; n = 150 and α = 0.92; T2; n = 62) and test-retest reliability (intraclass correlation coefficient (ICC) > 0.84, p < 0.001) within the KOA sample.In individuals with KOA, mindset is associated with future physical activity levels and relates to the individual's management strategy. Mindset is a reliable and malleable construct and may be a valuable target for increasing physical activity and improving adherence to rehabilitation strategies involving exercise among individuals with KOA.

  View details for DOI 10.1016/j.rehab.2022.101634

  View details for PubMedID 35091113

• Making sense of a pandemic: Mindsets influence emotions, behaviors, health, and wellbeing during the COVID-19 pandemic. Social science & medicine (1982) Zion, S. R., Louis, K., Horii, R., Leibowitz, K., Heathcote, L. C., Crum, A. J. 2022: 114889

  Abstract

  RATIONALE: As the SARS-COV-2 virus spread across the world in the early months of 2020, people sought to make sense of the complex and rapidly evolving situation by adopting mindsets about what the pandemic was and what it meant for their lives.OBJECTIVE: We aimed to measure the mindsets of American adults over the first six months of the COVID-19 pandemic to understand their relative stability over time and their relationship with emotions, behaviors, experiences, and wellbeing.METHODS: American adults (N=5,365) were recruited in early March of 2020 to participate in a longitudinal survey with follow-up surveys at 6-weeks and 6-months. Three mindsets that people formed about the COVID-19 pandemic were measured: 'the pandemic is a catastrophe', 'the pandemic is manageable' and 'the pandemic can be an opportunity'.RESULTS: In line with our pre-registered hypotheses, these mindsets were associated with a unique and largely self-fulfilling pattern of emotions (positive, negative), behaviors (healthy, unhealthy, and compliance with CDC guidelines), experiences (growth/connection, isolation/meaninglessness) and wellbeing (physical health, mental health, quality of life). Moreover, mindsets formed in the first week of the pandemic were associated with quality of life 6 months later, an effect that was mediated by emotions and health behaviors.CONCLUSION: The mindsets that people adopted about the COVID-19 pandemic - that it is 'a catastrophe', 'manageable', or 'an opportunity' may explain some of the heterogeneity in the lived experiences of Americans through their self-fulfilling impact on peoples' emotions, health behaviors, and wellbeing.

  View details for DOI 10.1016/j.socscimed.2022.114889

  View details for PubMedID 35430098

• Emphasizing pleasure over health promotes preference for nutritious foods in people of low socioeconomic status. Appetite Boles, D. Z., Turnwald, B. P., Perry, M. A., Crum, A. J. 1800: 105945

  Abstract

  People of low socioeconomic status (SES) have disproportionately poorer dietary health despite efforts to improve access and highlight the health benefits of nutritious foods. While health-focused labels and advertisements make healthier options easier to recognize, they can prime a number of negative associations about healthy foods (e.g., taste, satiety, cost), which may be particularly aversive for low SES groups. This within-subjects study recruited people of low and high SES (those without and with a college degree) and compared their product expectations, experiences, satiety, and choice when consuming a bottled fruit and vegetable smoothie promoted as pleasurable ("Crave") or as healthy ("Nutralean"). Relative to Nutralean, Crave improved product expectations and behavioral measures of satiety across all participants. However, Crave enhanced expectations, experiences, and product choice more for low SES than high SES participants. Importantly, improvements were achieved without deception of nutritional facts and without decreasing perceived healthiness or increasing perceived cost. These findings identify SES as an important moderator in health-focused promotion and suggest how the rapidly growing healthy food industry can more effectively appeal to low SES groups, contexts which the majority of Americans navigate.

  View details for DOI 10.1016/j.appet.2022.105945

  View details for PubMedID 35093457

• Language in popular American culture constructs the meaning of healthy and unhealthy eating: Narratives of craveability, excitement, and social connection in movies, television, social media, recipes, and food reviews. Appetite Turnwald, B. P., Perry, M. A., Jurgens, D., Prabhakaran, V., Jurafsky, D., Markus, H. R., Crum, A. J. 1800: 105949

  Abstract

  Many people want to eat healthier but struggle to do so, in part due to a dominant perception that healthy foods are at odds with hedonic goals. Is the perception that healthy foods are less appealing than unhealthy foods represented in language across popular entertainment media and social media? Six studies analyzed dialogue about food in six cultural products - creations of a culture that reflect its perspectives - including movies, television, social media posts, food recipes, and food reviews. In Study 1 (N = 617 movies) and Study 2 (N = 27 television shows), healthy foods were described with fewer appealing descriptions (e.g., "couldn't stop eating"; d = 0.59 and d = 0.37, respectively) and more unappealing descriptions (e.g., "I hate peas"; d = -.57 and d = -.63, respectively) than unhealthy foods in characters' speech from the film and television industries. Using sources with richer descriptive language, Studies 3-6 analyzed popular American restaurants' Facebook posts (Study 3, N = 2275), recipe descriptions from Allrecipes.com (Study 4, N = 1000), Yelp reviews from six U.S. cities (Study 5, N = 4403), and Twitter tweets (Study 6, N = 10,000) for seven specific themes. Meta-analytic results across Studies 3-6 showed that healthy foods were specifically described as less craveworthy (d = 0.51, 95% CI: 0.44-0.59), less exciting (d = 0.40, 95% CI: 0.31-0.49), and less social (d = 0.36, 95% CI: 0.04-0.68) than unhealthy foods. Machine learning methods further generalized patterns across 1.6 million tweets spanning 42 different foods representing a range of nutritional quality. These data suggest that strategies to encourage healthy choices must counteract pervasive narratives that dissociate healthy foods from craveability, excitement, and social connection in individuals' everyday lives.

  View details for DOI 10.1016/j.appet.2022.105949

  View details for PubMedID 35090976

• Nutritional Analysis of Foods and Beverages Posted in Social Media Accounts of Highly Followed Celebrities. JAMA network open Turnwald, B. P., Anderson, K. G., Markus, H. R., Crum, A. J. 1800; 5 (1): e2143087

  Abstract

  Importance: Celebrity social media posts engage millions of young followers daily, but the nutritional quality of foods and beverages in such posts, sponsored and unsponsored, is unknown.Objective: To quantify the nutritional quality of foods and beverages depicted in social media accounts of highly followed celebrities and assess whether nutritional quality is associated with post sponsorship, celebrity profession or gender, and followers' likes and comments.Design, Setting, and Participants: This cross-sectional study analyzed the content of food- and beverage-containing posts from Instagram (a photo- and video-sharing social media platform) accounts of 181 highly followed athletes, actors, actresses, television personalities, and music artists. Data were collected from May 2019 to March 2020.Main Outcomes and Measures: The nutritional quality of foods and beverages posted in celebrity social media accounts was rated using the Nutrient Profile Index (NPI) based on the sugar, sodium, energy, saturated fat, fiber, protein, and fruit and/or vegetable content per 100-g sample (a score of 0 indicated least healthy and 100, healthiest); foods with scores less than 64 and beverages with scores less than 70 were rated as "less healthy." Secondary outcomes were whether the nutritional quality of foods and beverages in social media posts was associated with post sponsorship, celebrity profession or gender, and followers' likes and comments. Mixed-effects regression models were used to estimate how outcomes differed across fixed effects.Results: The sample included social media accounts of 181 celebrities (66 actors, actresses, and television personalities [36.5%]; 64 music artists [35.4%]; and 51 athletes [28.2%]). A total of 102 celebrities (56.4%) were male, and the median age was 32 years (range, 17-73 years). Among 3065 social media posts containing 5180 total foods and beverages (2467 foods [47.6%]; 2713 beverages [52.4%]), snacks and sweets (920 [37.3%] of the foods) and alcoholic beverages (1375 [50.7%] of the beverages) were most common. Overall, 158 celebrity social media accounts (87.3%) earned a less healthy overall food nutrition score and 162 (89.5%) earned a less healthy overall beverage nutrition score, which would be unhealthy enough to fail legal youth advertising limits in the UK. For foods, social media posts with healthier nutrition scores were associated with significantly fewer likes (b, -0.003; 95% CI, -0.006 to 0.000; P=.04) and comments (b, -0.006; 95% CI, -0.009 to -0.003; P<.001) from followers. For beverages, nutrition scores were not significantly associated with likes (b, -0.010; 95% CI, -0.025 to 0.005; P=.18) or comments (b, -0.003; 95% CI, -0.022 to 0.016; P=.73). Only 147 food- or beverage-containing posts (4.8%) were sponsored by food- or beverage-relevant companies. Beverages in sponsored posts contained more than twice as much alcohol as those in nonsponsored posts (10.8 g [95% CI, 9.3 g to 12.3 g] per 100 g of beverage vs 5.3 g [95% CI, 4.7 g to 5.9 g] per 100 g of beverage).Conclusions and Relevance: In this cross-sectional study, most highly followed celebrity social media accounts depicted an unhealthy profile of foods and beverages, primarily in nonsponsored posts. These results suggest that influential depictions of unhealthy food and beverage consumption on social media may be a sociocultural problem that extends beyond advertisements and sponsorships, reinforcing unhealthy consumption norms.

  View details for DOI 10.1001/jamanetworkopen.2021.43087

  View details for PubMedID 35019982

• Thriving Under Pressure: The Effects of Stress-Related Wise Interventions on Affect, Sleep, and Exam Performance for College Students From Disadvantaged Backgrounds EMOTION Goyer, J., Akinola, M., Grunberg, R., Crum, A. J. 2021

  Abstract

  Nearly all students experience stress as they pursue important academic goals. Because stress can be magnified for students from disadvantaged backgrounds, it becomes important to identify interventions that can help mitigate this stress, particularly for these populations as they enter academic environments. We examine the effects of stress mindset and stress management interventions administered to students from disadvantaged backgrounds (N = 140) before freshman year. We compare effects on affect, sleep, and performance during end-of-year exams seen in a subset of these students who could be tracked via experience sampling (N = 57) to those of a comparison group at the same elite university (N = 74) receiving no such stress interventions. As predicted, we find significant differences in exam-week positive affect between the stress mindset and comparison groups. However, there was no difference in positive affect between the stress mindset and management groups or the stress management and comparison groups. For negative affect, stress, sleep, and exam performance, we find no significant differences between any of the three groups. However, both stress interventions decoupled the significant negative association between exam-week stress and exam performance exhibited by the comparison group, rendering the relationship nonsignificant. The reduction in this association was somewhat more pronounced for the mindset relative to the management group. These findings suggest that mindset and management approaches both confer benefits in certain circumstances and highlight the potential value of targeting mindsets about stress using a "wise intervention" approach for students from disadvantaged backgrounds during stressful times. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

  View details for DOI 10.1037/emo0001026

  View details for Web of Science ID 000733217200001

  View details for PubMedID 34780237

• "Consensus on Placebo and Nocebo Effects Connects Science with Practice:" Reply to "Questioning the Consensus on Placebo and Nocebo Effects". Psychotherapy and psychosomatics Evers, A. W., Colloca, L., Blease, C., Gaab, J., Jensen, K. B., Atlas, L. Y., Beedie, C. J., Benedetti, F., Bingel, U., Buchel, C., Bussemaker, J., Colagiuri, B., Crum, A. J., Finniss, D. G., Geers, A. L., Howick, J., Klinger, R., Meeuwis, S. H., Meissner, K., Napadow, V., Petrie, K. J., Rief, W., Smeets, I., Wager, T. D., Wanigasekera, V., Vase, L., Kelley, J. M., Kirsch, I., onbehalfoftheConsortiumofPlaceboExperts 2021: 1–2

  View details for DOI 10.1159/000514435

  View details for PubMedID 33631769

• Changing mindsets about side effects. BMJ open Leibowitz, K. A., Howe, L. C., Crum, A. J. 2021; 11 (2): e040134

  Abstract

  Given research showing that the very act of communicating side effects can increase their likelihood, how can providers inform patients about side effects while upholding their oath to do no unnecessary harm? An emerging approach provides a potential solution: truthfully describe certain minor side effects as a sign the treatment is active and working in the body. This approach focuses on instilling adaptive mindsets about the meaning of side effects while still keeping patients informed. This article describes existing research suggesting that this approach can be helpful in improving experience and outcomes in treatments for pain, hypertension and allergy. Compared with control groups given a standard, empathetic message about side effects, patients who were informed that side effects are a sign treatment is working were less anxious about side effects and rated them as less threatening and intense. A longitudinal, randomised controlled trial of this approach in patients receiving oral immunotherapy for food allergies found that describing side effects as a sign treatment was working reduced the rate at which patients contacted providers with concerns about side effects and led to greater increases in a biomarker of allergic tolerance from pretreatment to post-treatment (peanut-specific blood IgG4). In unveiling this approach, this article also raises important issues regarding which treatments and symptoms this approach should be applied to. Finally, we outline questions future research should address to further understand and leverage this approach.

  View details for DOI 10.1136/bmjopen-2020-040134

  View details for PubMedID 33526496

• The Taste-Focused-Labeling Intervention Emphasizing the Tasty and Enjoyable Attributes of Healthy Foods HANDBOOK OF WISE INTERVENTIONS Turnwald, B. P., Crum, A. J., Walton, G. M., Crum, A. J. 2021: 286-302

  View details for Web of Science ID 000647636100013

• The Stress-Mindset Intervention HANDBOOK OF WISE INTERVENTIONS Crum, A. J., Handley-Miner, I. J., Smith, E. N., Walton, G. M., Crum, A. J. 2021: 217-238

  View details for Web of Science ID 000647636100010

• Can Exercising and Eating Healthy Be Fun and Indulgent Instead of Boring and Depriving? Targeting Mindsets About the Process of Engaging in Healthy Behaviors. Frontiers in psychology Boles, D. Z., DeSousa, M., Turnwald, B. P., Horii, R. I., Duarte, T., Zahrt, O. H., Markus, H. R., Crum, A. J. 2021; 12: 745950

  Abstract

  This paper investigates mindsets about the process of health behaviors-the extent to which people associate physical activity and healthy eating with appealing (pleasurable, fun, indulgent) versus unappealing (unpleasant, boring, depriving) qualities-to promote greater engagement. Study 1 (N = 536) examined how mindsets about physical activity and healthy eating relate to current and future health behavior. Study 2 (N = 149) intervened in actual fitness classes to compare the effects of brief appeal-focused and health-focused interventions on mindsets about physical activity and class engagement. Study 3 (N = 140) designed nutrition education classes that emphasized either the appeal or the importance of fruits and vegetables for health and compared its effects on mindsets about healthy eating and actual fruit and vegetable consumption. Holding more appealing mindsets about health behaviors predicts subsequent physical activity and healthy eating (Study 1). An intervention targeting mindsets about the appeal of physical activity promotes greater participation in fitness classes than emphasizing the importance of meeting activity guidelines (Study 2). Meanwhile, interventions targeting mindsets about the appeal of healthy eating increases in-class fruit and vegetable selection more than emphasizing the importance of eating nutritious foods (Study 3), however additional work is needed to sustain such changes in eating behavior. These studies suggest mindsets about the process of health behaviors can be influential and changeable factors in motivating physical activity and healthy eating.

  View details for DOI 10.3389/fpsyg.2021.745950

  View details for PubMedID 34712186

• Handbook of Wise Interventions HOW SOCIAL PSYCHOLOGY CAN HELP PEOPLE CHANGE Introduction HANDBOOK OF WISE INTERVENTIONS Walton, G. M., Crum, A. J., Walton, G. M., Crum, A. J. 2021: 1-5

  View details for Web of Science ID 000647636100001

• Nutritional Analysis of Foods and Beverages Depicted in Top-Grossing US Movies, 1994-2018. JAMA internal medicine Turnwald, B. P., Handley-Miner, I. J., Samuels, N. A., Markus, H. R., Crum, A. J. 2020

  Abstract

  Importance: Many countries now restrict advertisements for unhealthy foods. However, movies depict foods and beverages with nutritional quality that is unknown, unregulated, and underappreciated as a source of dietary influence.Objective: To compare nutritional content depicted in top-grossing US movies with established nutrition rating systems, dietary recommendations, and US individuals' actual consumption.Design and Setting: In this qualitative study, a content analysis was performed from April 2019 to May 2020 of the 250 top-grossing US movies released from 1994 to 2018.Main Outcomes and Measures: The proportion of movies with less healthy nutrition ratings using the Nutrient Profile Index, the proportion of movies with medium or high food nutrition ratings according to the United Kingdom's "traffic light" guidelines (in which green is low and indicates the healthiest foods; amber, medium; and red is high and indicates the least healthy foods), and how the movie-depicted nutritional content compared with US Food and Drug Administration-recommended daily levels and US individuals' actual consumption according to National Health and Nutrition Examination Survey 2015-2016 data. Secondary outcomes compared branded and nonbranded items and tested whether outcomes changed over time or for movies targeting youths.Results: Across 9198 foods and 5748 beverages, snacks and sweets (2173 [23.6%]) and alcoholic beverages (2303 [40.1%]) were most commonly depicted. Alcohol comprised 23 of 127 beverages (18.1%) in G-rated movies, 268 of 992 beverages (27.0%) in PG-rated movies, 1503 of 3592 beverages (41.8%) in PG-13-rated movies, and 509 of 1037 beverages (49.1%) in R-rated movies. Overall, 178 of 245 movies (72.7%) earned less healthy Nutrient Profile Index food ratings and 222 of 246 movies (90.2%) earned less healthy beverage ratings, which would be unhealthy enough to fail legal limits for advertising to youths in the United Kingdom. Among foods, most movies depicted medium or high (amber or red traffic light) levels of sugar (229 of 245 [93.5%]), saturated fat (208 of 245 [84.9%]), total fat (228 of 245 [93.1%]), and, to a lesser extent, sodium (123 of 245 [50.2%]). Only 1721 foods and beverages (11.5%) were visibly branded, but branded items received less healthy nutrition ratings than nonbranded items. Overall, movies failed recommended levels of saturated fat per 2000 kcal by 25.0% (95% CI, 20.6%-29.9%), sodium per 2000 kcal by 3.9% (95% CI, 0.2%-7.9%), and fiber per 2000 kcal by 45.1% (95% CI, 42.9%-47.0%). Movies also depicted 16.5% (95% CI, 12.3%-21.0%) higher total sugar content per 2000 kcal and 313% (95% CI, 298%-329%) higher alcohol content per 2000 kcal than US individuals consume. Neither food nor beverage nutrition scores improved over time or among movies targeting youths.Conclusions and Relevance: This study suggests that popular US movies depict an unhealthy diet that fails national dietary recommendations, akin to US individuals' actual diets. Depicting unhealthy consumption in media is a sociocultural problem that extends beyond advertisements and branded product placements.

  View details for DOI 10.1001/jamainternmed.2020.5421

  View details for PubMedID 33226424

• Five-Star Prices, Appealing Healthy Item Descriptions? Expensive Restaurants' Descriptive Menu Language HEALTH PSYCHOLOGY Turnwald, B. P., Anderson, K. G., Jurafsky, D., Crum, A. J. 2020; 39 (11): 975–85

  Abstract

  Objective: Prior research shows that America's top-selling inexpensive casual dining restaurants use less appealing language to describe healthy menu items than standard items. This may suggest to diners that healthy options are less tasty and enjoyable. The present research asked whether expensive restaurants also use less appealing language to describe healthy items, or whether healthy items are described with equally appealing language as standard items in high status dining contexts. Method: Using Yelp, the name and description of every food item were recorded from the menus of 160 top-rated expensive restaurants across 8 U.S. cities (Nitems = 3,295; Nwords = 32,516). Healthy menu items were defined as salads and side vegetables, and standard items as all other dishes (excluding desserts), with high interrater reliability (K = .89). Descriptive words were categorized into 22 predefined themes, and log likelihood analyses compared normalized theme frequencies from standard item and healthy item descriptions. Results: Healthy items were described with 4.8-times fewer American region words, 2.7-times fewer exciting words, 1.4-times fewer tasty words, and significantly fewer portion size, spicy, artisanal, and foreign region words. Unlike inexpensive restaurants, however, expensive restaurants did not use any health-focused themes to promote healthy items and used several appealing themes more frequently in healthy item descriptions. Conclusions: Like inexpensive restaurants, expensive American restaurants described healthy items as less appealing and less authentically American than standard foods, but to a lesser extent. Implications for ordering behavior and solutions for improving the appeal of healthy menu items are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

  View details for DOI 10.1037/hea0001025

  View details for Web of Science ID 000582383700004

  View details for PubMedID 32940527

• What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus. Psychotherapy and psychosomatics Evers, A. W., Colloca, L., Blease, C., Gaab, J., Jensen, K. B., Atlas, L. Y., Beedie, C. J., Benedetti, F., Bingel, U., Buchel, C., Bussemaker, J., Colagiuri, B., Crum, A. J., Finniss, D. G., Geers, A. L., Howick, J., Klinger, R., Meeuwis, S. H., Meissner, K., Napadow, V., Petrie, K. J., Rief, W., Smeets, I., Wager, T. D., Wanigasekera, V., Vase, L., Kelley, J. M., Kirsch, I., ConsortiumofPlaceboExperts 2020: 1–8

  Abstract

  INTRODUCTION: Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments.OBJECTIVE: There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information.METHODS: Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients.RESULTS: There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities.CONCLUSIONS: The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients' needs, and on developing standardized disclosure training modules for clinicians.

  View details for DOI 10.1159/000510738

  View details for PubMedID 33075796

• The Future of Women in Psychological Science. Perspectives on psychological science : a journal of the Association for Psychological Science Gruber, J., Mendle, J., Lindquist, K. A., Schmader, T., Clark, L. A., Bliss-Moreau, E., Akinola, M., Atlas, L., Barch, D. M., Barrett, L. F., Borelli, J. L., Brannon, T. N., Bunge, S. A., Campos, B., Cantlon, J., Carter, R., Carter-Sowell, A. R., Chen, S., Craske, M. G., Cuddy, A. J., Crum, A., Davachi, L., Duckworth, A. L., Dutra, S. J., Eisenberger, N. I., Ferguson, M., Ford, B. Q., Fredrickson, B. L., Goodman, S. H., Gopnik, A., Greenaway, V. P., Harkness, K. L., Hebl, M., Heller, W., Hooley, J., Jampol, L., Johnson, S. L., Joormann, J., Kinzler, K. D., Kober, H., Kring, A. M., Paluck, E. L., Lombrozo, T., Lourenco, S. F., McRae, K., Monin, J. K., Moskowitz, J. T., Natsuaki, M. N., Oettingen, G., Pfeifer, J. H., Prause, N., Saxbe, D., Smith, P. K., Spellman, B. A., Sturm, V., Teachman, B. A., Thompson, R. J., Weinstock, L. M., Williams, L. A. 2020: 1745691620952789

  Abstract

  There has been extensive discussion about gender gaps in representation and career advancement in the sciences. However, psychological science itself has yet to be the focus of discussion or systematic review, despite our field's investment in questions of equity, status, well-being, gender bias, and gender disparities. In the present article, we consider 10 topics relevant for women's career advancement in psychological science. We focus on issues that have been the subject of empirical study, discuss relevant evidence within and outside of psychological science, and draw on established psychological theory and social-science research to begin to chart a path forward. We hope that better understanding of these issues within the field will shed light on areas of existing gender gaps in the discipline and areas where positive change has happened, and spark conversation within our field about how to create lasting change to mitigate remaining gender differences in psychological science.

  View details for DOI 10.1177/1745691620952789

  View details for PubMedID 32901575

• Cancer Survivorship-Considering Mindsets. JAMA oncology Heathcote, L. C., Zion, S. R., Crum, A. J. 2020

  View details for DOI 10.1001/jamaoncol.2020.2482

  View details for PubMedID 32644098

• Integrating Wearables in Stress Management Interventions: Promising Evidence From a Randomized Trial INTERNATIONAL JOURNAL OF STRESS MANAGEMENT Smith, E. N., Santoro, E., Moraveji, N., Susi, M., Crum, A. J. 2020; 27 (2): 172–82

  View details for DOI 10.1037/str0000137

  View details for Web of Science ID 000529343600007

• Using social and behavioural science to support COVID-19 pandemic response. Nature human behaviour Bavel, J. J., Baicker, K., Boggio, P. S., Capraro, V., Cichocka, A., Cikara, M., Crockett, M. J., Crum, A. J., Douglas, K. M., Druckman, J. N., Drury, J., Dube, O., Ellemers, N., Finkel, E. J., Fowler, J. H., Gelfand, M., Han, S., Haslam, S. A., Jetten, J., Kitayama, S., Mobbs, D., Napper, L. E., Packer, D. J., Pennycook, G., Peters, E., Petty, R. E., Rand, D. G., Reicher, S. D., Schnall, S., Shariff, A., Skitka, L. J., Smith, S. S., Sunstein, C. R., Tabri, N., Tucker, J. A., Linden, S. v., Lange, P. v., Weeden, K. A., Wohl, M. J., Zaki, J., Zion, S. R., Willer, R. 2020

  Abstract

  The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.

  View details for DOI 10.1038/s41562-020-0884-z

  View details for PubMedID 32355299

• Optimizing stress: An integrated intervention for regulating stress responses. Emotion (Washington, D.C.) Crum, A. J., Jamieson, J. P., Akinola, M. 2020; 20 (1): 120–25

  Abstract

  The dominant cultural valuation of stress is that it is "bad for me." This valuation leads to regulatory goals of reducing or avoiding stress. In this article, we propose an alternative approach-stress optimization-which integrates theory and research on stress mindset (e.g., Crum, Salovey, & Achor, 2013) and stress reappraisal (e.g., Jamieson, Mendes, Blackstock, & Schmader, 2010) interventions. We further integrate these theories with the extended process model of emotion regulation (Gross, 2015). In so doing, we explain how altering second-level valuation systems-shifting the valuation of stress from "is bad for me" to "can be good for me"-fundamentally changes the overarching goal of stress regulation from reducing stress to optimizing stress responses to achieve valued goals. With this optimization goal in mind, individuals are invited to flexibly identify, select, and engage in specific regulation tactics (e.g., situation selection, attentional control, cognitive change, and response modulation) in ways that help them achieve valued ends as opposed to merely reducing or avoiding stressful experiences. We discuss definitions and issues related to key terms including stress, stressors, stress responses, and stress regulation and outline a research agenda for testing this new integrated theory as an intervention. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

  View details for DOI 10.1037/emo0000670

  View details for PubMedID 31961190

• Effects of physical activity recommendations on mindset, behavior and perceived health. Preventive medicine reports Zahrt, O. H., Crum, A. J. 2020; 17: 101027

  Abstract

  This research sought to understand if physical activity recommendations--an integral component of many interventions aiming to promote physical activity--may have unexpected effects on individuals' mindsets (in this case about the adequacy and health consequences of their physical activity) that can strengthen or weaken recommendation effectiveness. Participants were students and staff at a U.S. West Coast private university, recruited between 2016 and 2019. Two experiments with one-week follow-up periods investigated the effects of viewing recommendations that prescribe a lower (vs. higher) amount of physical activity and provide a liberal (vs. stringent) definition of what counts as physical activity on individuals' mindsets about the adequacy and health consequences of their physical activity, as well as physical activity-related self-efficacy, physical activity behavior, and perceived health. Study 1 (N = 157) showed that exposure to low-and-liberal recommendations (vs. high-and-stringent recommendations) caused participants to adopt the mindset that their physical activity was more adequate, which in turn predicted greater engagement in physical activity and perceived health one week later. Study 2 (N = 272) showed that regardless of definition of physical activity (liberal vs. stringent), a lower (vs. higher) amount of recommended physical activity led participants to adopt the mindset that their activity was more adequate. This more adaptive mindset predicted greater self-efficacy and engagement in physical activity in the following week, in addition to better perceived health. Rather than inducing complacency, recommendations prescribing a relatively lower (vs. higher) amount of physical activity may be more effective at promoting physical activity and health by inducing adaptive mindsets.

  View details for DOI 10.1016/j.pmedr.2019.101027

  View details for PubMedID 31921575

  View details for PubMedCentralID PMC6948259

• What constitutes a 'successful' recovery? Patient perceptions of the recovery process after a traumatic injury. Trauma surgery & acute care open Rosenberg, G., Zion, S. R., Shearer, E., Bereknyei Merrell, S., Abadilla, N., Spain, D. A., Crum, A. J., Weiser, T. G. 2020; 5 (1): e000427

  Abstract

  Background: As the number of patients surviving traumatic injuries has grown, understanding the factors that shape the recovery process has become increasingly important. However, the psychosocial factors affecting recovery from trauma have received limited attention. We conducted an exploratory qualitative study to better understand how patients view recovery after traumatic injury.Methods: This qualitative, descriptive study was conducted at a Level One university trauma center. Participants 1-3years postinjury were purposefully sampled to include common blunt-force mechanisms of injuries and a range of ages, socioeconomic backgrounds and injury severities. Semi-structured interviews explored participants' perceptions of self and the recovery process after traumatic injury. Interviews were transcribed verbatim; the data were inductively coded and thematically analyzed.Results: We conducted 15 interviews, 13 of which were with male participants (87%); average hospital length of stay was 8.9 days and mean injury severity score was 18.3. An essential aspect of the patient experience centered around the recovery of both the body and the 'self', a composite of one's roles, values, identities and beliefs. The process of regaining a sound sense of self was essential to achieving favorable subjective outcomes. Participants expressed varying levels of engagement in their recovery process, with those on the high end of the engagement spectrum tending to speak more positively about their outcomes. Participants described their own subjective interpretations of their recovery as most important, which was primarily influenced by their engagement in the recovery process and ability to recover their sense of self.Discussion: Patients who are able to maintain or regain a cohesive sense of self after injury and who are highly engaged in the recovery process have more positive assessments of their outcomes. Our findings offer a novel framework for healthcare providers and researchers to use as they approach the issue of recovery after injury with patients.Level of evidence: III-descriptive, exploratory study.

  View details for DOI 10.1136/tsaco-2019-000427

  View details for PubMedID 32154383

• Increasing Vegetable Intake by Emphasizing Tasty and Enjoyable Attributes: A Randomized Controlled Multisite Intervention for Taste-Focused Labeling. Psychological science Turnwald, B. P., Bertoldo, J. D., Perry, M. A., Policastro, P., Timmons, M., Bosso, C., Connors, P., Valgenti, R. T., Pine, L., Challamel, G., Gardner, C. D., Crum, A. J. 2019: 956797619872191

  Abstract

  Healthy food labels tout health benefits, yet most people prioritize tastiness in the moment of food choice. In a preregistered intervention, we tested whether taste-focused labels compared with health-focused labels increased vegetable intake at five university dining halls throughout the United States. Across 137,842 diner decisions, 185 days, and 24 vegetable types, taste-focused labels increased vegetable selection by 29% compared with health-focused labels and by 14% compared with basic labels. Vegetable consumption also increased. Supplementary studies further probed the mediators, moderators, and boundaries of these effects. Increased expectations of a positive taste experience mediated the effect of taste-focused labels on vegetable selection. Moderation tests revealed greater effects in settings that served tastier vegetable recipes. Taste-focused labels outperformed labels that merely contained positive words, fancy words, or lists of ingredients. Together, these studies show that emphasizing tasty and enjoyable attributes increases vegetable intake in real-world settings in which vegetables compete with less healthy options.

  View details for DOI 10.1177/0956797619872191

  View details for PubMedID 31577177

• When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction. Frontiers in psychiatry Howe, L. C., Leibowitz, K. A., Crum, A. J. 2019; 10: 475

  Abstract

  Background: Research demonstrates that the placebo effect can influence the effectiveness of medical treatments and accounts for a significant proportion of healing in many conditions. However, providers may differ in the degree to which they consciously or unconsciously leverage the forces that produce placebo effects in clinical practice. Some studies suggest that the manner in which providers interact with patients shapes the magnitude of placebo effects, but this research has yet to distill the specific dimensions of patient-provider interactions that are most likely to influence placebo response and the mechanisms through which aspects of patient-provider interactions impact placebo response. Methods: We offer a simplifying and unifying framework in which interactions that boost placebo response can be dissected into two key dimensions: patients' perceptions of competence, or whether a doctor "gets it" (i.e., displays of efficiency, knowledge, and skill), and patients' perceptions of warmth, or whether a doctor "gets me" (i.e., displays of personal engagement, connection, and care for the patient). Results: First, we discuss how this framework builds on past research in psychology on social perception of competence and warmth and in medical literature on models of effective medical care, patient satisfaction, and patient-provider interactions. Then we consider possible mechanisms through which competence and warmth may affect the placebo response in healthcare. Finally, we share original data from patients and providers highlighting how this framework applies to healthcare. Both patient and provider data illustrate actionable ways providers can demonstrate competence and warmth to patients. Discussion: We conclude with recommendations for how researchers and practitioners alike can more systematically consider the role of provider competence and warmth in patient-provider interactions to deepen our understanding of placebo effects and, ultimately, enable providers to boost placebo effects alongside active medications (i.e., with known medical ingredients) and treatment in clinical care.

  View details for DOI 10.3389/fpsyt.2019.00475

  View details for PubMedID 31333518

  View details for PubMedCentralID PMC6619399

• When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction FRONTIERS IN PSYCHIATRY Howe, L. C., Leibowitz, K. A., Crum, A. J. 2019; 10

  View details for DOI 10.3389/fpsyt.2019.00475

  View details for Web of Science ID 000474276100001

• The Role of Patient Beliefs in Open-Label Placebo Effects HEALTH PSYCHOLOGY Leibowitz, K. A., Hardebeck, E. J., Goyer, J., Crum, A. J. 2019; 38 (7): 613–22

  Abstract

  Recent research on open-label placebos, or placebos administered without deception or concealment, suggests that they can be effective in a variety of conditions. The current research sought to unpack the mechanisms underlying the treatment efficacy of open-label placebos.A health care provider induced an allergic reaction in 148 participants via a histamine skin prick test. Participants were then exposed to 1 of 4 conditions additively leveraging various mechanisms of open-label placebo treatments: a supportive patient-provider relationship, a medical ritual, positive expectations, and a rationale about the power of placebos.There were no main effects of condition on allergic responses. However, participant beliefs about placebos moderated the effect of open-label placebo treatment condition on physiological allergic reactions: the condition including all 4 components of open-label placebos (a supportive patient-provider relationship, a medical ritual, positive expectations, and a rationale about the power of placebos) significantly reduced physiological allergic reaction among participants with a strong belief in placebos compared with participants in the control group.Participants' beliefs about placebos interact with information from the provider to reduce physiological allergic reactions in response to an open-label placebo treatment. This study underscores the importance of measuring and understanding how participants' beliefs influence outcomes of treatment, and furthers our understanding of when and how open-label placebo treatments work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

  View details for DOI 10.1037/hea0000751

  View details for Web of Science ID 000472220600006

  View details for PubMedID 31021124

• Smart food policy for healthy food labeling: Leading with taste, not healthiness, to shift consumption and enjoyment of healthy foods (vol 119, pg 7, 2019) PREVENTIVE MEDICINE Turnwald, B. P., Crum, A. J. 2019; 123: 344

  View details for DOI 10.1016/j.ypmed.2019.02.024

  View details for Web of Science ID 000468336900048

• Changing Patient Mindsets about Non-Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE Howe, L. C., Leibowitz, K. A., Perry, M. A., Bitler, J. M., Block, W., Kaptchuk, T. J., Nadeau, K. C., Crum, A. J. 2019; 7 (5): 1550–59

  View details for DOI 10.1016/j.jaip.2019.01.022

  View details for Web of Science ID 000467072700022

• Americans' Health Mindsets: Content, Cultural Patterning, and Associations With Physical and Mental Health ANNALS OF BEHAVIORAL MEDICINE Conner, A. L., Boles, D. Z., Markus, H., Eberhardt, J. L., Crum, A. J. 2019; 53 (4): 321–32

  View details for DOI 10.1093/abm/kay041

  View details for Web of Science ID 000480802100002

• Americans' Health Mindsets: Content, Cultural Patterning, and Associations With Physical and Mental Health. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine Conner, A. L., Boles, D. Z., Markus, H. R., Eberhardt, J. L., Crum, A. J. 2019; 53 (4): 321–32

  Abstract

  BACKGROUND: Health mindsets are mental frameworks that help people recognize, organize, interpret, and respond to health-relevant information. Although mindsets shape health behaviors and outcomes, no study has examined the health mindsets of ethnically and socioeconomically diverse Americans.PURPOSE: We explored the content, cultural patterning, and health correlates of diverse Americans' health mindsets.METHODS: Two studies surveyed approximately equal numbers of African American, Asian American, European American, and Latinx American men and women of lower and higher socioeconomic status (SES). Study 1 (N = 334) used open-ended questions to elicit participants' mindsets about the definitions, causes, and benefits of health. Study 2 (N = 320) used Study 1's results to develop a closed-ended instrument.RESULTS: In Study 1, open-ended questioning revealed six overarching mindset themes: behavioral, medical, physical, psychological, social, and spiritual. The most prevalent mindsets were psychological definitions, behavioral causes, and psychological benefits. Participants mentioned more cause themes than definition or benefit themes, and mindset theme mentions correlated with worse health. Older participants mentioned more themes than younger, women mentioned more definition themes than men, and low-SES participants mentioned more cause themes than high-SES participants. In Study 2, closed-ended scales uncovered more complex and positive health mindsets. Psychological and spiritual benefit mindsets correlated with good mental health. African Americans and women endorsed the widest array of mindsets, and the spiritual benefit mindset partially explained the superior mental health of African Americans.CONCLUSIONS: Many Americans hold simplistic, illness-focused health mindsets. Cultivating more complex, benefit-focused, and culturally appropriate health mindsets could support health.

  View details for PubMedID 30892642

• Smart food policy for healthy food labeling: Leading with taste, not healthiness, to shift consumption and enjoyment of healthy foods PREVENTIVE MEDICINE Turnwald, B. P., Crum, A. J. 2019; 119: 7–13

  View details for DOI 10.1016/j.ypmed.2018.11.021

  View details for Web of Science ID 000455729700002

• Providers' Demeanor Impacts Patient Perceptions of Visit Length JOURNAL OF GENERAL INTERNAL MEDICINE Howe, L. C., Hardebeck, E. J., Leibowitz, K. A., Crum, A. J. 2019; 34 (2): 182-183

  View details for DOI 10.1007/s11606-018-4665-6

  View details for Web of Science ID 000458654700011

• Changing Patient Mindsets About Non-Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial. The journal of allergy and clinical immunology. In practice Howe, L. C., Leibowitz, K. A., Perry, M. A., Bitler, J. M., Block, W., Kaptchuk, T. J., Nadeau, K. C., Crum, A. J. 2019

  Abstract

  BACKGROUND: Oral immunotherapy (OIT) can lead to desensitization to food allergens, but patients can experience treatment-related symptoms of allergic reactions that cause anxiety and treatment dropout. Interventions to improve OIT for patients are needed.OBJECTIVE: To determine whether fostering the mindset that non-life-threatening symptoms during OIT can signal desensitization improves treatment experience and outcomes.METHODS: In a randomized, blinded, controlled phase II study, 50 children/adolescents (28% girls, aged 7-17, M=10.82, SD=3.01) completed six-month OIT for peanut allergies. Patients and their parent(s) had monthly clinic visits at the Sean N. Parker Center for Allergy & Asthma Research between 1/5/2017-8/3/2017. All families received identical symptom management training. In a 1:1 approach, 24 patients and their families were informed that non-life-threatening symptoms during OIT were unfortunate side effects of treatment, and 26 patients and their families were informed that non-life-threatening symptoms could signal desensitization. Families participated in activities to reinforce these symptom mindsets.RESULTS: Compared to families informed that symptoms are side effects, families informed that symptoms can signal desensitization were less anxious (B=-0.46, 95% CI (-0.76 to -0.16), p=0.003), less likely to contact staff about symptoms (5/24[9.4%] vs. 27/154[17.5%] instances, p=0.036), experienced fewer non-life-threatening symptoms as doses increased (BInteraction=-0.54(-0.83 to -0.27), p<0.001), less likely to skip/reduce doses (1/26[4%] vs. 5/24[21%] patients, p=0.065), and showed greater increase in patient peanut-specific blood IgG4 levels (BInteraction=0.76(0.36 to 1.17), p<0.001).CONCLUSION: Fostering the mindset that symptoms can signal desensitization improves OIT experience and outcomes. Changing how providers inform patients about non-life-threatening symptoms is a promising avenue for improving treatment.

  View details for PubMedID 30682576

• Learning one's genetic risk changes physiology independent of actual genetic risk Nature Human Behaviour Turnwald, B. P., Goyer, J. P., Boles, D. Z., Silder, A., Delp, S. L., Crum, A. J. 2019; 3: 48-56

  View details for DOI 10.1038/s41562-018-0483-4

• Targeting Mindsets, Not Just Tumors Trends in Cancer Zion, S. R., Schapira, L., Crum, A. J. 2019

  View details for DOI 10.1016/j.trecan.2019.08.001

• Learning one's genetic risk changes physiology independent of actual genetic risk. Nature human behaviour Turnwald, B. P., Goyer, J. P., Boles, D. Z., Silder, A., Delp, S. L., Crum, A. J. 2019; 3 (1): 48-56

  Abstract

  Millions of people now access personal genetic risk estimates for diseases such as Alzheimer's, cancer and obesity1. While this information can be informative2-4, research on placebo and nocebo effects5-8 suggests that learning of one's genetic risk may evoke physiological changes consistent with the expected risk profile. Here we tested whether merely learning of one's genetic risk for disease alters one's actual risk by making people more likely to exhibit the expected changes in gene-related physiology, behaviour and subjective experience. Individuals were genotyped for actual genetic risk and then randomly assigned to receive either a 'high-risk' or 'protected' genetic test result for obesity via cardiorespiratory exercise capacity (experiment 1, N = 116) or physiological satiety (experiment 2, N = 107) before engaging in a task in which genetic risk was salient. Merely receiving genetic risk information changed individuals' cardiorespiratory physiology, perceived exertion and running endurance during exercise, and changed satiety physiology and perceived fullness after food consumption in a self-fulfilling manner. Effects of perceived genetic risk on outcomes were sometimes greater than the effects associated with actual genetic risk. If simply conveying genetic risk information can alter actual risk, clinicians and ethicists should wrestle with appropriate thresholds for when revealing genetic risk is warranted.

  View details for DOI 10.1038/s41562-018-0483-4

  View details for PubMedID 30932047

• Stress, Mindsets, and Success in Navy SEALs Special Warfare Training. Frontiers in psychology Smith, E. N., Young, M. D., Crum, A. J. 2019; 10: 2962

  Abstract

  Mindsets can impact an individual's performance in stressful experiences such as public speaking or receiving negative feedback. Yet we know little about the boundary conditions of where these mindsets predict success, and where they may become irrelevant or even maladaptive. The current research asks whether mindsets are beneficial in environments of extreme physical and mental stress using participants undergoing the notoriously challenging Navy SEALs training. We hypothesized that participants with stress-is-enhancing mindsets - who believe stress enhances their health, performance and wellbeing - will outperform those with stress-is-debilitating mindsets. In addition, we explore whether other mindsets about willpower and failure predict success in a similar manner. Following 174 Navy SEALs candidates, we find that, even in this extreme setting, stress-is-enhancing mindsets predict greater persistence through training, faster obstacle course times, and fewer negative evaluations from peers and instructors. We also find evidence that failure-is-enhancing mindsets may be detrimental to candidates' success, and non-limited willpower mindsets prompt negative evaluations from others. Multiverse analyses were conducted to test for the robustness of these effects across researcher analytical decisions, which produced consistent results. We discuss how findings in this unique environment can provide insight into the importance of mindsets in other organizations and propose future avenues of research to further understand the causal role of mindsets in diverse workplace contexts.

  View details for DOI 10.3389/fpsyg.2019.02962

  View details for PubMedID 32010023

• Physician Assurance Reduces Patient Symptoms in US Adults: an Experimental Study JOURNAL OF GENERAL INTERNAL MEDICINE Leibowitz, K. A., Hardebeck, E. J., Goyer, J., Crum, A. J. 2018; 33 (12): 2051-2052

  View details for DOI 10.1007/s11606-018-4627-z

  View details for Web of Science ID 000451437800014

• Smart food policy for healthy food labeling: Leading with taste, not healthiness, to shift consumption and enjoyment of healthy foods. Preventive medicine Turnwald, B. P., Crum, A. J. 2018

  Abstract

  Smart food policy models for improving dietary intake recommend tailoring interventions to people's food preferences. Yet, despite people citing tastiness as their leading concern when making food choices, healthy food labels overwhelmingly emphasize health attributes (e.g., low caloric content, reductions in fat or sugar) rather than tastiness. Here we compared the effects of this traditional health-focused labeling approach to a taste-focused labeling approach on adults' selection and enjoyment of healthy foods. Four field studies (total N = 4273) across several dining settings in northern California in 2016-2017 tested whether changing healthy food labels to emphasize taste and satisfaction rather than nutritional properties would encourage more people to choose them (Studies 1-2), sustain healthy purchases over the long-term (Study 3), and improve both the perceived taste of and mindsets about healthy foods (Study 4). Compared to health-focused labeling, taste-focused labeling increased choice of vegetables (OR = 1.73, 95% CI: 1.32, 2.26), salads (OR = 2.06, 95% CI: 1.06, 4.06), and vegetable wraps (OR = 3.09, 95% CI: 1.73, 5.65) in Studies 1-2. In Study 3, taste-focused labeling sustained vegetarian entree purchases over a two-month period, while health-focused labeling led to a 45.1% decrease. In Study 4, taste-focused labeling significantly enhanced post-consumption ratings of vegetable deliciousness and improved mindsets about the deliciousness of healthy foods compared to health-focused labeling. These studies demonstrate that taste-focused labeling is a low-cost strategy that increased healthy food selection by 38% and outperforms health-focused labeling on multiple smart food policy mechanisms.

  View details for PubMedID 30508553

• Beliefs About Stress Attenuate the Relation Among Adverse Life Events, Perceived Distress, and Self-Control. Child development Park, D., Yu, A., Metz, S. E., Tsukayama, E., Crum, A. J., Duckworth, A. L. 2018; 89 (6): 2059–69

  Abstract

  Prior research has shown that adverse events in the lives of adolescents precipitate psychological distress, which in turn impairs self-control. This study (N=1,343) examined the protective effects of stress mindsets-beliefs about the extent to which stress might be beneficial or strictly detrimental. The results confirmed that increasing the number of adverse life events across the school year predicted rank order increases in perceived distress, which in turn predicted rank order decreases in self-control. Adolescents who believed in the potential benefits of stress were less prone to feeling stressed in the wake of adverse life events. These findings suggest that changing the way adolescents think about stress may help protect them from acting impulsively when confronted with adversity.

  View details for PubMedID 28872676

• Beliefs About Stress Attenuate the Relation Among Adverse Life Events, Perceived Distress, and Self-Control CHILD DEVELOPMENT Park, D., Yu, A., Metz, S. E., Tsukayama, E., Crum, A. J., Duckworth, A. L. 2018; 89 (6): 2059-2069

  View details for DOI 10.1111/cdev.12946

  View details for Web of Science ID 000452463400021

• Providers' Demeanor Impacts Patient Perceptions of Visit Length. Journal of general internal medicine Howe, L. C., Hardebeck, E. J., Leibowitz, K. A., Crum, A. J. 2018

  View details for PubMedID 30215175

• Physician Assurance Reduces Patient Symptoms in US Adults: an Experimental Study. Journal of general internal medicine Leibowitz, K. A., Hardebeck, E. J., Goyer, J. P., Crum, A. J. 2018

  View details for PubMedID 30128787

• Catechol-O-Methyltransferase moderates effect of stress mindset on affect and cognition PLOS ONE Crum, A. J., Akinola, M., Turnwald, B. P., Kaptchuk, T. J., Hall, K. T. 2018; 13 (4): e0195883

  Abstract

  There is evidence that altering stress mindset-the belief that stress is enhancing vs. debilitating-can change cognitive, affective and physiological responses to stress. However individual differences in responsiveness to stress mindset manipulations have not been explored. Given the previously established role of catecholamines in both placebo effects and stress, we hypothesized that genetic variation in catechol-O-methyltransferase (COMT), an enzyme that metabolizes catecholamines, would moderate responses to an intervention intended to alter participants' mindsets about stress. Participants (N = 107) were exposed to a stress mindset manipulation (videos highlighting either the enhancing or debilitating effects of stress) prior to engaging in a Trier Social Stress task and subsequent cognitive tasks. The associations of the COMT rs4680 polymorphism with the effect of stress mindset video manipulations on cognitive and affective responses were examined. Genetic variation at rs4680 modified the effects of stress mindset on affective and cognitive responses to stress. Individuals homozygous for rs4680 low-activity allele (met/met) were responsive to the stress-is-enhancing mindset manipulation as indicated by greater increases in positive affect, improved cognitive functioning, and happiness bias in response to stress. Conversely, individuals homozygous for the high-activity allele (val/val) were not as responsive to the stress mindset manipulation. These results suggest that responses to stress mindset intervention may vary with COMT genotype. These findings contribute to the understanding of gene by environment interactions for mindset interventions and stress reactivity and therefore warrant further investigations.

  View details for PubMedID 29677196

• Mindsets Matter: A New Framework for Harnessing the Placebo Effect in Modern Medicine NEUROBIOLOGY OF THE PLACEBO EFFECT, PT I Zion, S. R., Crum, A. J., Colloca, L. 2018; 138: 137-160

  View details for DOI 10.1016/bs.irn.2018.02.002

  View details for Web of Science ID 000436628500009

• Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus PSYCHOTHERAPY AND PSYCHOSOMATICS Evers, A. M., Colloca, L., Blease, C., Annoni, M., Atlas, L. Y., Benedetti, F., Bingel, U., Buechel, C., Carvalho, C., Colagiuri, B., Crum, A. J., Enck, P., Gaab, J., Geers, A. L., Howick, J., Jensen, K. B., Kirsch, I., Meissner, K., Napadow, V., Peerdeman, K. J., Raz, A., Rief, W., Vase, L., Wager, T. D., Wampold, B. E., Weimer, K., Wiech, K., Kaptchuk, T. J., Klinger, R., Kelley, J. M. 2018; 87 (4): 204–10

  Abstract

  Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice.A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated.There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects.The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice.

  View details for PubMedID 29895014

• Optimizing stress responses with reappraisal and mindset interventions: an integrated model ANXIETY STRESS AND COPING Jamieson, J. P., Crum, A. J., Goyer, J., Marotta, M. E., Akinola, M. 2018; 31 (3): 245–61

  Abstract

  The dominant perspective in society is that stress has negative consequences, and not surprisingly, the vast majority of interventions for coping with stress focus on reducing the frequency or severity of stressors. However, the effectiveness of stress attenuation is limited because it is often not possible to avoid stressors, and avoiding or minimizing stress can lead individuals to miss opportunities for performance and growth. Thus, during stressful situations, a more efficacious approach is to optimize stress responses (i.e., promote adaptive, approach-motivated responses). Objectives and Conclusions: In this review, we demonstrate how stress appraisals (e.g., [Jamieson, J. P., Nock, M. K., & Mendes, W. B. (2012). Mind over matter: reappraising arousal improves cardiovascular and cognitive responses to stress. Journal of Experimental Psychology: General, 141(3), 417-422. doi: 10.1037/a0025719 ]) and stress mindsets (e.g., [Crum, A. J., Salovey, P., & Achor, S. (2013). Rethinking stress: The role of mindsets in determining the stress response. Journal of Personality and Social Psychology, 104(4), 716-733. doi: 10.1037/a0031201 ]) can be used as regulatory tools to optimize stress responses, facilitate performance, and promote active coping. Respectively, these interventions invite individuals to (a) perceive stress responses as functional and adaptive, and (b) see the opportunity inherent in stress. We then propose a novel integration of reappraisal and mindset models to maximize the utility and effectiveness of stress optimization. Additionally, we discuss future directions with regard to how stress responses unfold over time and between people to impact outcomes in the domains of education, organizations, and clinical science.

  View details for PubMedID 29471669

• Mindsets Matter: A New Framework for Harnessing the Placebo Effect in Modern Medicine. International review of neurobiology Zion, S. R., Crum, A. J. 2018; 138: 137–60

  Abstract

  The clinical utility of the placebo effect has long hinged on physicians deceptively administering an objective placebo treatment to their patients. However, the power of the placebo does not reside in the sham treatment itself; rather, it comes from the psychosocial forces that surround the patient and the treatment. To this end, we propose a new framework for understanding and leveraging the placebo effect in clinical care. In outlining this framework, we first present the placebo effect as a neurobiological effect that is evoked by psychological processes. Next, we argue that along with implicit learning and expectation formation, mindsets are a key psychological process involved in the placebo effect. Finally, we illustrate the critical role of the social environment and treatment context in shaping these psychological processes. In doing so, we offer a guide for how the placebo effect can be understood, harnessed, and leveraged in the practice of modern medicine.

  View details for PubMedID 29681322

• Selection Does Not Equate Consumption Reply JAMA INTERNAL MEDICINE Turnwald, B. P., Boles, D. Z., Crum, A. J. 2017; 177 (12): 1875–76

  View details for DOI 10.1001/jamainternmed.2017.6728

  View details for Web of Science ID 000417000700052

• Making mindset matter. BMJ (Clinical research ed.) Crum, A. J., Leibowitz, K. A., Verghese, A. 2017; 356: j674-?

  View details for DOI 10.1136/bmj.j674

  View details for PubMedID 28202443

• The role of stress mindset in shaping cognitive, emotional, and physiological responses to challenging and threatening stress. Anxiety, stress, and coping Crum, A. J., Akinola, M., Martin, A., Fath, S. 2017: 1-17

  Abstract

  Prior research suggests that altering situation-specific evaluations of stress as challenging versus threatening can improve responses to stress. The aim of the current study was to explore whether cognitive, physiological and affective stress responses can be altered independent of situation-specific evaluations by changing individuals' mindsets about the nature of stress in general.Using a 2 × 2 design, we experimentally manipulated stress mindset using multi-media film clips orienting participants (N = 113) to either the enhancing or debilitating nature of stress. We also manipulated challenge and threat evaluations by providing positive or negative feedback to participants during a social stress test.Results revealed that under both threat and challenge stress evaluations, a stress-is-enhancing mindset produced sharper increases in anabolic ("growth") hormones relative to a stress-is-debilitating mindset. Furthermore, when the stress was evaluated as a challenge, a stress-is-enhancing mindset produced sharper increases in positive affect, heightened attentional bias towards positive stimuli, and greater cognitive flexibility, whereas a stress-is-debilitating mindset produced worse cognitive and affective outcomes.These findings advance stress management theory and practice by demonstrating that a short manipulation designed to generate a stress-is-enhancing mindset can improve responses to both challenging and threatening stress.

  View details for DOI 10.1080/10615806.2016.1275585

  View details for PubMedID 28120622

• Reading Between the Menu Lines: Are Restaurants' Descriptions of "Healthy" Foods Unappealing? Health psychology : official journal of the Division of Health Psychology, American Psychological Association Turnwald, B. P., Jurafsky, D. n., Conner, A. n., Crum, A. J. 2017

  Abstract

  As obesity rates continue to climb in America, much of the blame has fallen on the high-calorie meals at popular chain restaurants. Many restaurants have responded by offering "healthy" menu options. Yet menus' descriptions of healthy options may be less attractive than their descriptions of less healthy, standard options. This study examined the hypothesis that the words describing items in healthy menu sections are less appealing than the words describing items in standard menu sections.Menus from the top-selling American casual-dining chain restaurants with dedicated healthy submenus (N = 26) were examined, and the library of words from health-labeled items (N = 5,873) was compared to that from standard menu items (N = 38,343) across 22 qualitative themes (e.g., taste, texture).Log-likelihood ratios revealed that restaurants described healthy items with significantly less appealing themes and significantly more health-related themes. Specifically, healthy items were described as less exciting, fun, traditional, American regional, textured, provocative, spicy hot, artisanal, tasty, and indulgent than standard menu items, but were described with significantly more foreign, fresh, simple, macronutrient, deprivation, thinness, and nutritious words.Describing the most nutritious menu options in less appealing terms may perpetuate beliefs that healthy foods are not flavorful or indulgent, and may undermine customers' choice of healthier dining options. From a public health perspective, incorporating more appealing descriptive language to boost the appeal of nutritious foods may be one avenue to improve dietary health. (PsycINFO Database Record

  View details for PubMedID 28541069

• Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Howe, L. C., Goyer, J. P., Crum, A. J. 2017; 36 (11): 1074–82

  Abstract

  Research on placebo/nocebo effects suggests that expectations can influence treatment outcomes, but placebo/nocebo effects are not always evident. This research demonstrates that a provider's social behavior moderates the effect of expectations on physiological outcomes.After inducing an allergic reaction in participants through a histamine skin prick test, a health care provider administered a cream with no active ingredients and set either positive expectations (cream will reduce reaction) or negative expectations (cream will increase reaction). The provider demonstrated either high or low warmth, or either high or low competence.The impact of expectations on allergic response was enhanced when the provider acted both warmer and more competent and negated when the provider acted colder and less competent.This study suggests that placebo effects should be construed not as a nuisance variable with mysterious impact but instead as a psychological phenomenon that can be understood and harnessed to improve treatment outcomes. (PsycINFO Database Record

  View details for PubMedID 28277699

• Changing Mindsets to Enhance Treatment Effectiveness. JAMA Crum, A. n., Zuckerman, B. n. 2017; 317 (20): 2063–64

  View details for PubMedID 28418538

• Perceived physical activity and mortality: Evidence from three nationally representative U.S. samples. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Zahrt, O. H., Crum, A. J. 2017; 36 (11): 1017–25

  Abstract

  This research sought to examine the relationship of individuals' perceptions about their level of physical activity with mortality outcomes at the population level.This study used 3 nationally representative samples with a total sample size of 61,141 U.S. adults (weighted N = 476 million). Data from the 1990 National Health Interview Survey (NHIS) and the 1999-2002/2003-2006 National Health and Nutrition Examination Survey (NHANES) were linked to prospective National Death Index mortality data through 2011, yielding follow-up periods of up to 21 years. Cox proportional hazards models were used to determine the association between respondents' perceptions of their relative level of physical activity (compared with other people their age) and all-cause mortality, adjusting for actual levels of physical activity, health status and behavior, and sociodemographic variables.Perceived physical activity relative to peers was associated with mortality risk. Individuals who perceived themselves as less active than others were up to 71% more likely to die in the follow-up period than those who perceived themselves as more active. This finding held across 3 samples and after adjusting for actual levels of physical activity and other covariates.Individuals' perceptions about their level of physical activity strongly predicted mortality, even after accounting for the effects of actual physical activity and other known determinants of mortality. This suggests that perceptions about health behaviors may play an important role in shaping health outcomes. (PsycINFO Database Record

  View details for PubMedID 28726475

• Association Between Indulgent Descriptions and Vegetable Consumption: Twisted Carrots and Dynamite Beets. JAMA internal medicine Turnwald, B. P., Boles, D. Z., Crum, A. J. 2017

  View details for PubMedID 28604924

• Adaptive Appraisals of Anxiety Moderate the Association between Cortisol Reactivity and Performance in Salary Negotiations PLOS ONE Akinola, M., Fridman, I., Mor, S., Morris, M. W., Crum, A. J. 2016; 11 (12)

  Abstract

  Prior research suggests that stress can be harmful in high-stakes contexts such as negotiations. However, few studies actually measure stress physiologically during negotiations, nor do studies offer interventions to combat the potential negative effects of heightened physiological responses in negotiation contexts. In the current research, we offer evidence that the negative effects of cortisol increases on negotiation performance can be reduced through a reappraisal of anxiety manipulation. We experimentally induced adaptive appraisals by randomly assigning 97 male and female participants to receive either instructions to appraise their anxiety as beneficial to the negotiation or no specific instructions on how to appraise the situation. We also measured participants' cortisol responses prior to and following the negotiation. Results revealed that cortisol increases were positively related to negotiation performance for participants who were told to view anxiety as beneficial, and not detrimental, for negotiation performance (appraisal condition). In contrast, cortisol increases were negatively related to negotiation performance for participants given no instructions on appraising their anxiety (control condition). These findings offer a means through which to combat the potentially deleterious effects of heightened cortisol reactivity on negotiation outcomes.

  View details for DOI 10.1371/journal.pone.0167977

  View details for Web of Science ID 000392758000019

  View details for PubMedID 27992484

  View details for PubMedCentralID PMC5161466

• Transforming Water: Social Influence Moderates Psychological, Physiological, and Functional Response to a Placebo Product PLOS ONE Crum, A. J., Phillips, D. J., Goyer, J. P., Akinola, M., Higgins, E. T. 2016; 11 (11)

  Abstract

  This paper investigates how social influence can alter physiological, psychological, and functional responses to a placebo product and how such responses influence the ultimate endorsement of the product. Participants consumed a product, "AquaCharge Energy Water," falsely-labeled as containing 200 mg of caffeine but which was actually plain spring water, in one of three conditions: a no social influence condition, a disconfirming social influence condition, and a confirming social influence condition. Results demonstrated that the effect of the product labeling on physiological alertness (systolic blood pressure), psychological alertness (self-reported alertness), functional alertness (cognitive interference), and product endorsement was moderated by social influence: participants experienced more subjective, physiological and functional alertness and stronger product endorsement when they consumed the product in the confirming social influence condition than when they consumed the product in the disconfirming social influence condition. These results suggest that social influence can alter subjective, physiological, and functional responses to a faux product, in this case transforming the effects of plain water.

  View details for DOI 10.1371/journal.pone.0167121

  View details for Web of Science ID 000388886000052

  View details for PubMedID 27875567

  View details for PubMedCentralID PMC5119827

• Self-Fulfilling Prophesies, Placebo Effects, and the Social-Psychological Creation of Reality Emerging Trends in the Social and Behavioral Sciences Scott, R., Kosslyn , S. John Wiley & Sons, Inc. 2015
• Rethinking Stress: The Role of Mindsets in Determining the Stress Response JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY Crum, A. J., Salovey, P., Achor, S. 2013; 104 (4): 716-733

  Abstract

  This article describes 3 studies that explore the role of mindsets in the context of stress. In Study 1, we present data supporting the reliability and validity of an 8-item instrument, the Stress Mindset Measure (SMM), designed to assess the extent to which an individual believes that the effects of stress are either enhancing or debilitating. In Study 2, we demonstrate that stress mindsets can be altered by watching short, multimedia film clips presenting factual information biased toward defining the nature of stress in 1 of 2 ways (stress-is-enhancing vs. stress-is-debilitating). In Study 3, we demonstrate the effect of stress mindset on physiological and behavioral outcomes, showing that a stress-is-enhancing mindset is associated with moderate cortisol reactivity and high desire for feedback under stress. Together, these 3 studies suggest that stress mindset is a distinct and meaningful variable in determining the stress response.

  View details for DOI 10.1037/a0031201

  View details for Web of Science ID 000316620300007

  View details for PubMedID 23437923

• Mind Over Milkshakes: Mindsets, Not Just Nutrients, Determine Ghrelin Response HEALTH PSYCHOLOGY Crum, A. J., Corbin, W. R., Brownell, K. D., Salovey, P. 2011; 30 (4): 424-429

  Abstract

  To test whether physiological satiation as measured by the gut peptide ghrelin may vary depending on the mindset in which one approaches consumption of food.On 2 separate occasions, participants (n = 46) consumed a 380-calorie milkshake under the pretense that it was either a 620-calorie "indulgent" shake or a 140-calorie "sensible" shake. Ghrelin was measured via intravenous blood samples at 3 time points: baseline (20 min), anticipatory (60 min), and postconsumption (90 min). During the first interval (between 20 and 60 min) participants were asked to view and rate the (misleading) label of the shake. During the second interval (between 60 and 90 min) participants were asked to drink and rate the milkshake.The mindset of indulgence produced a dramatically steeper decline in ghrelin after consuming the shake, whereas the mindset of sensibility produced a relatively flat ghrelin response. Participants' satiety was consistent with what they believed they were consuming rather than the actual nutritional value of what they consumed.The effect of food consumption on ghrelin may be psychologically mediated, and mindset meaningfully affects physiological responses to food.

  View details for DOI 10.1037/a0023467

  View details for Web of Science ID 000292809100006

  View details for PubMedID 21574706

• Mind-set matters: Exercise and the placebo effect PSYCHOLOGICAL SCIENCE Crum, A. J., Langer, E. J. 2007; 18 (2): 165-171

  Abstract

  In a study testing whether the relationship between exercise and health is moderated by one's mind-set, 84 female room attendants working in seven different hotels were measured on physiological health variables affected by exercise. Those in the informed condition were told that the work they do (cleaning hotel rooms) is good exercise and satisfies the Surgeon General's recommendations for an active lifestyle. Examples of how their work was exercise were provided. Subjects in the control group were not given this information. Although actual behavior did not change, 4 weeks after the intervention, the informed group perceived themselves to be getting significantly more exercise than before. As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. These results support the hypothesis that exercise affects health in part or in whole via the placebo effect.

  View details for Web of Science ID 000245157900014

  View details for PubMedID 17425538