By Nicolas Zuniga-Penaranda, MD, and Eugene C. Lee, MD, CYT
Dr. Zuniga is a Resident Physician in Family Medicine, MacNeal Hospital Loyola University Health System, Chicago.
Dr. Lee is an Assistant Professor of Family Medicine, MacNeal Family Medicine Residency, Berwyn, IL.
Summary Points
- Prior research has shown that prosocial behavior is correlated with improved health and happiness.
- Lazar and Eisenberger investigated the effect on short-term recovery after an acute stressor of a prosocial behavior vs. a self-rewarding behavior, as measured by self-reported mood and cardiovascular and chemical correlates of stress.
- After an acute stressor, the group randomized to engage in prosocial behavior had a statistically significant improvement in recovery of cardiovascular correlates of stress. There was no significant difference in self-reported mood or the chemical correlates of stress.
SYNOPSIS: Two randomized controlled studies were created to examine the effects of giving gifts vs. receiving gifts after stressful situations. They both revealed that the “giving” group reported recovering from stress more quickly, showing more happiness, having less desire, and reporting no significant difference in relaxation compared to the “receiving” group and a control group.
SOURCE: Lazar L, Eisenberger NI. The benefits of giving: Effects of prosocial behavior on recovery from stress. Psychophysiology 2022;59:e13954.
In light of the current pandemic, economic turmoil, and more, healthcare providers likely are acutely aware of the stressors that they and their patients face. Chronic stress is associated with increased morbidity. There are clear guidelines for treating anxiety disorders, but what can be done about plain old physiologic stress?
Many people use retail therapy, comfort food, or a cold drink to deal with stress.1 While some studies have suggested improved stress responses after certain self-care or self-rewarding behaviors, such as sauna sessions and massages, other behaviors, such as excess alcohol and comfort food consumption, have well-known risks.2,3 Suggested responses may include breathing or mindfulness techniques.
A growing body of research shows that prosocial behaviors, defined as behaviors done to benefit another person, can have a wide range of benefits.4 Correlational studies have found associations between prosocial behaviors and increased happiness, decreased depression, daily reductions in heart rate and blood pressure, and decreased mortality.5-8 There is a paucity of experimental studies on the subject, but two randomized controlled trials did show that prosocial behaviors reduced expression of the gene regulation program CtrA, which has been associated with stress, cancer, and cardiovascular disease.9-11
Lazar and Eisenberger built on this background and compared the effects of prosocial behavior to self-rewarding behavior. Across two studies, they investigated if a prosocial activity can speed recovery after stress more than a self-rewarding activity and the effect of giving vs. receiving on participants’ moods.
Methods
In Study 1, Lazar and Eisenberger subjected 91 healthy undergraduate student participants to the Trier Social Stress Test (TSST), followed by one of three interventions.
The TSST consists of the following: participants are told they will give a speech in front of a panel of judges, in which they must explain why they would be the best candidate for an administrative assistant position. They are given five minutes to prepare before delivering this speech in front of confederates, who are made to appear prestigious and stern. After the five-minute speech, participants then spend five minutes performing a surprise mental arithmetic test aloud.
As expected from this ghastly description, the TSST has been shown to reliably cause stress responses and routinely is used in acute stress research.12
Participants were randomly assigned to one of three interventions to perform after the TSST. Participants in the “giving” group chose a gift card to be given to a person of their choosing. Meanwhile, participants in the “receiving” group chose a gift card for themselves. Participants in the control group identified the more “aesthetically pleasing” gift card.
The study measured change in mood by an adapted Profile of Mood States short form (grouped into level of positive mood and level of negative mood), the chemical stress markers cortisol and salivary alpha-amylase (sAA), and the cardiovascular markers systolic and diastolic blood pressure (SBP and DBP), heart rate (HR), and mean arterial pressure (MAP). These were measured before the TSST, after the TSST, and after the intervention.
In Study 2, Lazar and Eisenberger repeated the above procedure (excluding the control condition) among 102 healthy undergraduate students, but they also had participants complete a shortened Discrete Emotions Questionnaire. This questionnaire had participants rate on a numerical scale the extent to which, during the gift card task, they experienced several emotions.
The emotions listed included only emotions grouped under subscales for happiness, desire, and relaxation. Responses were added together to get one total number value each for how much each participant reported experiencing happiness, desire, and relaxation.
Statistics
In Study 1, the researchers used one-way analyses of variance to compare baseline demographics and self-reported health measures. Participant sex and, because it was shows to be significantly different between groups, baseline depression levels were included as covariates for intervention analyses.
The effect of the TSST was measured by using repeated measures analyses of covariance (ANCOVAs) to compare baseline vs. post-TSST mood, chemical stress markers, and cardiovascular markers. The effect of the intervention was measured by using repeated measures ANCOVA to compare post-TSST vs. post-intervention.
In Study 2, researchers used independent samples t-tests to compare the reported happiness, desire, and relaxation emotions between participants in the “giving” vs. “receiving” intervention groups.
Results
The receiving group had significantly higher levels of depression on baseline assessment, compared to other groups. There were no other significant differences between demographics or baseline data.
The TSST significantly changed the measures of mood, cardiovascular markers, and chemical markers in the directions that would be expected for a stressful task. As detailed in Table 1, the “giving” intervention had no significant effect on the mood and chemical markers and had mixed effects on the cardiovascular markers. The “giving” intervention significantly or marginally significantly decreased HR, DBP, and MAP compared to both of the other groups, but had no statistically significant effect on SBP.
Table 1. Effects of Intervention in Study 1 |
|
| Mood | |
Negative mood (time by condition) |
F[2,85] = 0.49, P = 0.61 |
Positive mood (time by condition) |
F[2,85] = 1.25, P = 0.29 |
| Cardiovascular | |
Heart rate (time by condition)
|
F[4,146] = 3.37, P = 0.011*
|
Systolic blood pressure (time by condition) |
F[4,146] = 1.15, P = 0.336 |
Diastolic blood pressure (time by condition)
|
F[4,146] = 3.48, P = 0.009*
|
Mean arterial pressure (time by condition)
|
F[3.66,133.75], P = 0.03*
|
| Chemical | |
Cortisol (time by condition) |
F[3.21,136.32] = 1.17, P = 0.326 |
Salivary alpha-amylase (time by condition) |
F[4,162] = 0.19, P = 0.95 |
*Statistically significant value |
|
In Study 2, Lazar and Eisenberger revealed that the “giving” group reported significantly more happiness, less desire, and no significant difference in relaxation compared to the “receiving” group.
Commentary
The researchers noted some shortcomings and limitations. First, using a study population of healthy undergraduate students limits external validity. Second, the last saliva sample may have been collected too early to adequately detect the response to the intervention. Third, although sAA has been shown to rise quickly in response to stress, it may be affected by other signaling pathways as well.
In addition to these limitations, the study population of healthy undergraduate students is not representative of the general population. Additionally, the prosocial behavior used in this intervention came at no real or perceived cost to the participant; participants only chose to whom the researchers would give a gift card (and did not have the option of keeping it for themselves).
Furthermore, both the stressor and response measured were short-term, with the entire experiment including data collection taking only 90 minutes per participant. It is unclear if the results would be generalizable to chronic stress or to regular prosocial behavior over longer time periods.
In addition, as to be expected for a basic science study, it is difficult to apply these results directly to clinical practice: among the measures tracked, only “mood” can be considered a somewhat patient-centered outcome. Meanwhile, the only statistically significant intervention results in Study 1, quickened improvements in HR, DBP, MAP after a stress, are not clinically significant.
However, this small study adds to the growing body of research suggesting the benefits of prosocial behavior. Further research would be required to resolve the apparent discrepancy of the intervention causing a significant difference in only some of the cardiovascular measures and in none of the chemical or mood measures.
Additional research also could investigate whether this effect is reproducible in other populations, what types of prosocial actions are effective (beyond giving away a gift card at no cost to oneself), whether the effect is dependent on an individual’s personality traits or other factors, and if the benefit is limited to acute stress or also would help in chronic stress.
Stress is a very common complaint among patients and clinicians, so Lazar and Eisenberger have contributed to an important field of research. Study 1 showed statistically significant improvements in only some (but not all) of the cardiovascular measures of stress and found no effect in chemical or mood measures of stress.
However, when placed in the context of prior correlational and experimental studies summarized summarized earlier, which have suggested some benefits of prosocial behaviors, we can conclude that there is limited data that there may be a small benefit of prosocial behaviors on recovery from acute stress with negligible risk to these behaviors.
To borrow suggested recommendation phrasing from the American College of Cardiology and American Heart Association, two appropriate ways to think about whether we should recommend or try prosocial behaviors to deal with stress are that it “may be considered” or that its “effectiveness is… not well established.”13
References
- American Psychological Association. Stress a major health problem in the US, warns APA. Published Oct. 24, 2007. https://www.apa.org/news/press/releases/2007/10/stress
- Pilch W, Pokora I, Szyguła Z, et al. Effect of a single Finnish sauna session on white blood cell profile and cortisol levels in athletes and non-athletes. J Hum Kinet 2013;39:127-135.
- Rapaport MH, Schettler P, Bresee C. A preliminary study of the effects of repeated massage on hypothalamic–pituitary–adrenal and immune function in healthy individuals: A study of mechanisms of action and dosage. J Altern Complement Med 2012;18:789-797.
- Nelson SK, Layous K, Cole SW, Lyubomirsky S. Do unto others or treat yourself? The effects of prosocial and self-focused behavior on psychological flourishing. Emotion 2016;16:850-861.
- Dunn EW, Aknin LB, Norton MI. Spending money on others promotes happiness. Science 2008;319:1687-1688.
- Li Y, Ferraro KF. Volunteering and depression in later life: Social Benefit or selection processes? J Health Soc Behav 2005;46:68-84.
- Piferi RL, Lawler KA. Social support and ambulatory blood pressure: An examination of both receiving and giving. Int J Psychophysiol 2006;62:328-336.
- Brown SL, Nesse RM, Vinokur AD, Smith DM. Providing social support may be more beneficial than receiving it. Psychol Sci 2003;14:320-327.
- Regan A, Fritz MM, Walsh LC, et al. The genomic impact of kindness to self vs. others: A randomized controlled trial. Brain Behav Immun 2022;106:40-48.
- Nelson-Coffey SK, Fritz MM, Lyubomirsky S, Cole SW. Kindness in the blood: A randomized controlled trial of the gene regulatory impact of prosocial behavior. Psychoneuroendocrinology 2017;81:8-13.
- Cole SW. The conserved transcriptional response to adversity. Curr Opin Behav Sci 2019;28:31-37.
- Allen AP, Kennedy PJ, Dockray S, et al. The Trier Social Stress Test: Principles and practice. Neurobiol Stress 2016;6:113-126.
- Halperin JL, Levine GN, Al-Khatib SM, et al. Further evolution of the ACC/AHA clinical practice guideline recommendation classification system: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016;67:1572-1574.
Two randomized, controlled studies were created to examine the effects of giving gifts vs. receiving gifts after stressful situations. They both revealed the “giving” group reported recovering from stress faster, showing more happiness, showing less desire, and reporting no significant difference in relaxation compared to the “receiving” group and a control group.
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