br The association of increased eudaimonic well being with
The association of increased eudaimonic well-being with decreased CTRA gene Lipo2000 predominantly involved increased expression of antiviral and antibody-related genes from pre- to post-intervention, rather than reduced expression of pro-inflammatory genes over the intervention period. Some studies assessing eudaimonic well-being and the CTRA have not reported on the components of CTRA separately (Cole et al., 2015; Fredrickson et al., 2015), precluding direct com-parisons. At least one study, however, has similarly shown that eu-daimonic well-being was associated with the antiviral and antibody component of the CTRA (Fredrickson et al., 2013). Of note, Antoni et al. (2012) found that negative affect was associated with the pro-in-flammatory, but not the antiviral component of the CTRA in a sample of breast cancer survivors. Further investigation of the components of the CTRA and its psychological correlates is an important topic for future research. However, it is important not to over-interpret the differential significance of inflammatory and antiviral gene associations with eu-daimonic well-being in the current study, as these differences may also stem from sampling variability and the limited statistical power to detect true associations given this study’s relatively small sample size.
As has been previously observed (Cole et al., 2015; Fredrickson et al., 2015), the association between eudaimonic well-being and CTRA down-regulation was specific, with no association evident with de-pressive symptoms. This suggests that interventions targeting health in
vulnerable populations, such as breast cancer survivors, should not exclusively focus on reducing distress. There was also no association between CTRA expression and hedonic well-being. While closely re-lated and often co-occurring, eudaimonic and hedonic well-being are conceptually and empirically distinct (Ryff, 2018; Ryan and Deci, 2001) and may even have different neural substrates (Kringelbach and Berridge, 2009). Most notably, eudaimonic well-being, as defined in this and other studies, encompasses not only a subjective experience, but also a mode of being, or a striving towards optimal functioning (Ryan and Deci, 2001). The path to hedonic well-being, by contrast, can be heterogeneous and could involve permissive behaviors that under-mine health (e.g., excessive drinking, smoking, sedentary behavior). Although not a consistent pattern, some studies have found that higher hedonic well-being is associated with greater CTRA gene expression, net of its correlation with eudaimonic well-being (Fredrickson et al., 2013; Kitayama et al., 2016). r> The theoretical distinction between eudaimonic and hedonic well-being has significant implications for intervention design. Specifically, interventions that target eudaimonic well-being may lead to more lasting positive change than those that solely focus on hedonic well-being (Hernandez et al., 2017). Compared to hedonic behavior, eu-daimonic behaviors induce a greater variety of positive emotions (e.g., gratitude, contentment, joy) and are comprised of complex behaviors that are more self-perpetuating, less likely to lead to boredom, and less subject to hedonic adaptation (Layous and Lyubomirsky, 2014). Posi-tive activity interventions already incorporate eudaimonic activities (e.g., writing letters of gratitude, performing acts of kindness, engaging in self-affirmation exercises) and more traditional clinical psychological approaches, such as behavioral activation therapy, are also explicitly addressing constructs like meaning in life (Lejuez et al., 2011).
This study builds upon an emerging literature linking heightened eudaimonic well-being to gene expression alterations (Cole et al., 2015; Fredrickson et al., 2013, 2015; Kitayama et al., 2016), providing novel evidence that intervention-related change in well-being is associated with reduced CTRA gene expression over time. However, several im-portant limitations should be noted. This was a small pilot study in a highly stressed and vulnerable group, and results require replication in other populations. The absence of a control group precludes causal claims, although work from our lab and others has shown that inter-ventions such as mindfulness meditation increase eudaimonic well-being and decrease CTRA gene expression relative to a control group
(Antoni et al., 2016; Bower et al., 2015), supporting the hypothesis that the changes observed in this sample may be driven by the intervention. In addition, although we are interpreting results to support an effect of eudaimonic well-being on CTRA gene expression, it is also possible that changes in CTRA gene expression may drive changes in affect given the bidirectional links between the immune system and brain function (Dantzer et al., 2008). It is unclear whether the magnitude of molecular effects observed here, which were quantitatively modest, would have clinical significance, and future research will be required to assess the health impact of mindfulness meditation in the context of the highly stressful experience of cancer. Finally, while it is encouraging that our results held when controlling for important covariates (e.g., cancer treatment, BMI), these covariate-adjusted findings should be inter-preted with caution given the small sample size. Despite these limita-tions, our results contribute to a growing literature delineating the central psychological processes relevant to mitigating CTRA gene ex-pression, which represents a critical step in understanding how psy-chological well-being influences health.