..
Heartbreak sucks
Hi I’m Wendy Zukerman, you're listening to Science Vs. Today on the show we’re pitting facts against falling out of love... As we tackle heartbreak….
Science is about to help us with one of our most universal experiences: getting dumped.
Let’s meet Anabel…she's a Science Vs listener… and she told us about her big heartbreak… it all started when she was in college…
I was a sophomore. He was a junior and it was a total meet cute
It was the first day of English class and they were told to chat to someone new… for an ice breaker.
So I just turned to the person behind me and he was sitting right behind me and it was one of those like, Oh my gosh, like the world slowed down. I felt like butterflies. I was like, Oh, hello.
They hit it off. After that, they made a point of sitting next to each other in every class.. and the more Anabel learned about him, the more she started falling...
They started setting up some study dates... that turned into real dates... she remembers one where everything felt just perfect ... a day at the ball game
He was a big Angels fan. I'm a big Dodgers fan. And so that was a cute little like, Oh man, my team's gonna get your team. No, I'm gonna win. And it was so fun. …
it was just it was a beautiful day I was happy and laughing he was happy and laughing and just
I'm like, this is like a country song, I guess, you know, like taking my girl in my truck to my baseball game. And I was like, Oh, I love this. Like, I was like, they're going to write love stories about this.
And … Ok I gotta say, the sex was really great.
At one point, Anabel's boyfriend went to study abroad in the Netherlands ... she visited him... and during that trip, they had a blast …
And then the trip is over, it’s time for Anabel to go home – she's packing up her stuff, it's all pretty sad… and it's here where something kinda strange happens.. he asks her if she'll take some gifts back for his family…
I was like, yeah, sure. Um, is there anything else you want me to pack? And he's like, well, I have a journal. It was a red journal. It's the brand. Moleskine?
WZ A moleskine. A moleskine. Yes. Yes. Yes. Okay. Yeah. Yeah. Yeah. So like a deep red moleskin.
Red. Mhmm. He hands me the journal and he's like, Oh, but I don't know if I want you to read it or not. … I was like, huh? …
She packs the journal... gets on her flight… and as soon as she's back in the US Annabel is desperate to hear from him..
And yeah, so I race home, I open up my laptop, I, I see an email from him and he's like, I hope you made it home safe. I had an amazing time with you. Thank you so much for coming out. I love you so much.
I had a great time. Can't wait to see you again. Um, and about the journal, I decided I will let you read the journal. And I was like, Okay, he goes, but it's going to be hard for you to read. And there are some pages that are circled. And if they're circled, that means that's really going to be hard for you to read.
WZ What??
Clearly he planned it ahead of time
WZ Right??
Yeah. He's like, but I don't want this to change anything between us after you read it.
I read the journal …
He's saying that I'm a party girl that I'm a stoner… I did forget to mention that during his time in Europe there was this girl who kept popping up… and I was like, I don't I don't I don't really like her… She seems to be a little flirty with you… and he was totally gaslighting of like no, no, she's not. You're just imagining it… Well, shockingly, in the journal, find out he likes her. He's wanted to date her.
WZ What the f What the f Had he circled those bits? Did he know they would be hard for you to read? Oh my fucking
Yeah those were the pages that he circled. Uh, yeah.
He just, he was calling me a bitch.
He was writing a negative entry about me when I was there! …visting him! When I was done reading it… I threw the journal so hard across the room that it hit the wall and the spine of the journal broke off
A week later they met on Skype, and it was done. He actually didn’t have the guts to do it – Anabel broke it off. And even though she knew he'd done this dicky thing... she was so heartbroken... .
you would start replaying things of like, well, what if this was different? What if I did something different? I'm feeling this pain … And I'm so sad. And like, I should stop being sad. Why am I so sad? This is not normal
But it wasn't just feeling crappy in her head – she was in physical pain… she could feel this heartbreak in her whole body…
There was like a tightness in my chest that lingered for a while… and in my gut… so much so that I did kind of lose an appetite for about a week where even my friends were like, girl, you gotta eat.
So Anabel was a mess… and of course when it comes to heartbreak she is not alone. In fact, when we reached out to you all, we heard so many stories from people who'd been terribly heartbroken... and just felt so bad... Like just quickly -- here's another listener we'll hear from today… Matt… He'd been in totally in love with his boyfriend -- and when it finally ended - he just felt so damn awful
I just remember I, I physically hurt, like my heart and my chest hurt. It was hard for my brain to understand, like, why am I physically hurting so much?
That's so cliche. I'm like, ugh, ugh, like you're just another country song. Like get over it.
So today… we're gonna find out.. what is happening in our brains and bodies as we are down in the dumps… And - critically, what can science teach us about how to get over our exes. And get back to that THANK U NEXT happy place… Several years ago we dove into the science of heartbreak.. but today - we've updated the science and are dipping our toes back in…
When it comes to heartbreak there’s lots of…
This is not normal
But then there’s science… !
<<AHHH>
Science Vs coming right up after the break… the heart break
PREROLL
What heartbreak does in the brain
Welcome back. Today we’re finding out what science can tell us about heartbreak… And we want to start with… what is happening in our brain when someone stomps all over our heart ... So for this we need…
LB My name is Dr Lucy Brown - I’m a neuroscientist!
Lucy is a professor at Albert Einstein College of Medicine in New York[1] And she did this groundbreaking study on our brains on heartbreak… but she said that when her colleagues first found out that she wanted to study heartbreak… there were a lot of haters.
LB Neuroscientists said oh no it’s too messy, too much emotion, you can't study it scientifically, it seems magical ... We said, ehh we think maybe we can.
And so Lucy and a few colleagues took a crack at it. Their idea was that if you put heartbroken people into an MRI machine … maybe you could see heartbreak in their brains. Like perhaps their brains would light up in some unique way. First step. The heartbreak squad needed a bunch of people who were heart broken. Being at universities… they put out flyers all over the campus saying “Have you just been rejected in love but can’t let go?” Give us a call (!). And then as puffy-eyed college kids walked through their door… the researchers asked them a ton of questions to make sure that they were truly, truly heartbroken…
LB The main thing is that they can't stop thinking about the other person. That it’s really being obsessed with thinking about the other person. They’re crying a lot. They can't sleep.
15 sleep deprived sad sacks fit the bill for Lucy's experiment[2] … Now. Step 2. The brain scan. To make sure that their guinea pigs would be all sad and heartbroken while getting an MRI… the researchers asked them to bring in a photo of their once beloved's face, so they were looking into their dumper's eyes while they were in the scanner ...
LB Believe me, when you're in that machine and you open your eyes it’s like right there, you are immersed in that person, yeah.
WZ That must have been awful
LB Oh they were crying, you know remembering the heartbreak, yes. WZ they really came out crying… LB Oh yeah, yeah, tears in the scanner. Tears down their face. Yes.
To then see what was heartbreak and what was just regular brain… Lucy and her team needed to do one final thing. They had the same college kids – look at a photo of someone else while they were in the MRI -- someone they weren’t emotionally attached to at all. Then the researchers compared the two brain scans, and Lucy remembers when the results from each one started coming in
<i do I do…When I first put you know the first ten and then 12 and then 14… and I first looked at that, It was pretty amazing… haha
The experiment worked! She could SEE heartbreak in the brain ... and Lucy told us - about her very curious findings ..[3]
One of the things that was interesting, is that a part of the brain that registers physical pain was active.[4] So we weren’t feeling the physical pain, like a pinch or cut or a broken bone . But that part of the brain that says this hurts, that’s active.
WZ That’s so interesting, i think about that as different things. To break my leg, to break up with someone. But it's not that different?
LB It’s not that different. It’s not just the physical pain, it’s not just the emotional pain, those two are interacting all the time.
And this all fits with a growing body of research showing this connection between physical pain and emotional pain[5][6][7][8][9] …
It’s all suggesting that when people say “I’m hurting” — they are literally hurting. And this doesn’t just happen in heartbreak - it can also happen at other times like when we get rejected or left out of a game [10][11][12][13] - it’s what science calls “social rejection”. [14]
Ok, so that’s the hurting part of a break up. But Lucy also saw that when these heartbroken saps looked at their exes, another part of the brain lit up - the reward system[15]… this system gets triggers when we do stuff we like… eat chocolate[16], take drugs, you know the fun ones[17] - and when we’re in love.[18]
So it's this two things, it's causing them pain, but ah there he or she is, that face that gave so much pleasure, so many good times, made me feel so good in my heart!
What heartbreak does in the body
So we can see in their brains they crave their ex... but they can no longer have them and that's where heartbreak kicks in. And all this stuff going on in our brain — can have real effects on our body …
LB The brain is influencing the body, and all these systems are interacting.
So research has found, after losing a partner… certain hormones like cortisol can start racing around the body [19][20][21][22] .. This is a stress hormone.
And early research suggests this cascade of stress can cause real problems… surveys have found that it can affect your sleep… for sometimes months[23] [24].... It can also mess up your immune system[25][26][27], [28][29][30] And one more thing, heartache can quite literally hurt your heart.[31][32]... In ways that you can really feel!
You do, you feel a deep sunken tight feeling in your chest.
Now in some cases... you can get pain in your heart that’s quite serious …it's a type of heart failure[33] It’s known as Takotsubo [Tah-koh-tsu-boh] Syndrome [34][35] [36][37][38] [39][40] … During Takotsubos, one chamber of your heart balloons up in this very specific way[41] - which is actually where the syndrome gets its name from. Your heart starts to look like a Japanese octopus trap called a Takotsubo[42]… And you can get Takotsubos after other kinds of stress too - like public speaking[43] and there was even this case report about it happening to someone after they ate too much wasabi.[44]
So where does all this leave us? Well what we know now is that-- heartbreak can cause, real effects throughout your body - like increased stress hormones, and sleep problems and chest pains. So all you heartbroken folks out there –
LB You're not crazy. This is your brain, it's a physiological thing. You’re not to blame for this! Don’t blame yourself for all of this.
Matt and Anabel told us that knowing that heartbreak can cause real, physical pain ... was really helpful… and it’s something they'd wish they knew at the time…
Matt: I wouldn't have felt so stupid or silly for hurting. Would have been validating,
Anabel: I do feel more normalized. … If you're feeling physical pain, that, that's normal. That's, that's okay. You know, you're not just being a dramatic Disney princess.
After the break.. .the best science on how to get OVER your ex… Yes! Getting rid of the blood sucking vampire in your life.. is coming up…
BREAK
How to get over heartbreak
Welcome back! Today on the show. Heartbreak. We now know that it truly truly sucks to be heartbroken … and you can feel it through your body and brain… And now we want to know - How do you get over it?? And get to that … Heartbreak feels good in a place like this… place??
First up: Let's get some answers by looking into research in breaking bad habits.[45] So one thing which has been shown to help people is to stay away from triggers[46] or cues[47]. So for example, if you want to stop eating popcorn, don’t go to the cinema - there was actually a study on this and it helps[48]… if you want to quit smoking[49]… don’t have cigarettes around… . And when it comes to heartbreak, apply the same logic: if you want to stop thinking about your Ex. Clear out their text messages. Block them on instagram.
LB Throw away all of the, ALL of the things associated with that person. You should get rid of them… Go live somewhere else entirely if you’re really having a big problem! Just get away from there.
But if you can’t uproot your entire life to get over someone, we did find another helpful suggestion in the literature…and it’s called negative reappraisal. It’s a fancy science phrase for saying — just keep reminding yourself what a turd your ex was.[50] Anabel did a lot of this too.
Anabel: You know, like it would be, OK this was a red flag, so I shouldn't be so sad. Oh, okay. A little bit of the tightness went away. He never liked my friends, and that's important to me. … Okay. A little bit of the tightness went away.
And when it came to negative reappraisal, Annabel's mates were very helpful
A: You know, my friends being like, yeah, we fucking hated that guy, like, good on you for breaking up with him.
But it's not all just thinking "they were such a schmuck" -- and trust me -- they were a schmuck. On the flip side, research has found that it’s a good idea to try to reframe the breakup[51][52][53] … Like, don't think.. oh I wish I was different and then they would have liked me… instead, try to see that the relationship was holding you back, or that you grew from it, or that you couldn't truly be yourself around them… … You know – you realise I can buy myself flowers… I can hold my own hand… I can love me better than you can…
Anabel says, looking back, the breakup was absolutely the right step for her …
Anabel: Yeah, it was, it was so hard, but it was so necessary. Like the person I became after that was just the complete opposite of who I was going into it. …
WZ I feel like if I didn't have shitty relationships, then I wouldn't have been able to identify what a really good one is.
Anabel: 100% 100%
And if you're not ready for personal growth just yet -- take heart... time heals all wounds... or at least it can help! A survey of almost 200 Uni students found that people tended to be less distressed if there was more time since the breakup.[54] And it's not just humans - there's research about this into voles! <<VOLE SFX>> Voles little potato shaped rodents known for partnering up for life… And if scientists take away their lovers they get really stressed[55][56] ... But even they can get over a break up. And you can see in the chemicals in their body. So just this year, a study published[57] that found that soon after a breakup – voles would still get a dopamine hit when they saw their ex … after a while that dopamine surge… went away.
And for Matt, time was one thing that helped for sure…
Matt: Eventually I got to a place where when I did see him again, it didn't trigger me in any kind of way. In fact, it was like, I was almost annoyed. Like, ugh
Some studies have found that writing or journaling about your emotions post-breakup might make you feel a little bit better.[58][59][60] Therapy, also a good one - has been found to help too with those pesky ruminating thoughts.[61][62][63]
And then, just finally, there's some things that will help you get over a breakup that you can't read in the scientific literature. Ok so Matt loves to go out dancing. And it’s something his ex wouldn’t let him do. Matt’s ex could be abusive - like getting really jealous. And for Matt - not going out dancing?
Matt: That just killed me. I'm like, that's my joy. That's, that's everything. That's where my source of joy really is. I love to dance. And he's like, no, you can't do that anymore.
So when things ended and he was in that pit of despair … Matt still found something to make him feel better.. or someone.
Matt: The best way that I knew how to get through my feelings was dancing in my room. There was one set of CDs that I came back to and would go over and over again. And that is, one woman, the woman who is every woman, and that was Whitney Houston.
Whitney Houston’s greatest hits collection had just come out. And that he played that album on repeat. FIrst he listened to the sad tracks that made him cry like - “Didn’t we almost have it all.” And he’d ALWAYS finish dancing his heart out to one final track
Matt The song that meant the most to me was, um, “I want to dance with somebody (who loves me)” because that was really what I felt. I kept coming back to that moment over and over again where I had started dancing in the club with him and he just looked at me with disgust. When Whitney sings, “I wanna dance with somebody who loves me,” that was it. That was everything. That expressed everything that I ever wanted to express. That's where I found myself again. And so, even to this day, when I hear that song, like, it just like It brings me to this place of, yes, that's, that's what I want.
Years later – Matt’s doing great, he's totally over that relationship. So is Anabel. In fact - her current partner?
Anabel: He's literally the best person in the entire fucking world… I mean, he introduced me to Science Vs, I mean, clearly he's amazing. So like, clearly he's a really good person.
Ok! So when it comes to the science of heartbreak… it's real… You can see it in our brain…in our hearts and even in our immune system… and to hack your way out of heartbreak… try reminding yourself what a twerp they were… and avoiding triggers, like fun things you'd used to do together, don't drive past their house at night, Olivia Rodrigo - she know what was going on… and also -- don't discount the healing powers of Witney…
That's Science Vs – wait a sec… Is still have to tell you what became of that journal?? The red moleskine that started it all ... well ... after the break Anabel called up her step mom
Anabel: I was like, I'm not giving it back to him, but I don't want to just throw it away because I feel like that's not enough justice. And she just goes, burn it. I was like, I have to go. Um, there's going to be a bonfire.
WZ: Haha
Anabel: Was already living with one of my best friends, so I call another one of my girlfriends and I was like, Britney, we're having a bonfire tonight, and she was like, hells yeah.
She comes over, we take one of our pots from our kitchen, just like one of our sauce pots. … we go outside on the balcony … page by page, Wendy,
WZ: Oh you did it page by page?
Anabel: Oh we did it page by page
WZ: How did it feel as you were burning it?
Anabel: It was phenomenal. It was absolutely phenomenal. one of the things that he had problems with was me smoking weed with my friends. And he wrote about that multiple times in the journal. So, my best friend took one of those entries, rolled up a joint with it, And we used the flames of the burning journal to light the joint that I smoked.
WZ: Hahaha. That is so sweet.
Anabel: Yeah.
That’s Science Vs
CITATIONS: 64.
A very big thanks to the listeners who shared their heartbreak stories with us - we appreciate you! To look out for our future callouts, for share your stories with us, follow us on our socials - @science_vs on Instagram @wendyzukerman on TikTok
And we talked about some tough stuff in this episode, if you're going through a nasty, maybe even abusive relationship, - and you just want to talk to someone - we'll link to resources in the show notes
CREDITS
This episode was produced by Michelle Dang, with help from me, Wendy Zukerman, Rose Rimler, Meryl Horn, Kaitlyn Sawrey and Lexi Krupp. Editing by Caitlin Kenney and Blythe Terrell. Fact checking by Diane Kelly and Erica Akiko Howard. Mix and sound design by Peter Leonard and Bobby Lord. Music written by Peter Leonard, Bumi Hidaka, Emma Munger, and Bobby Lord. A huge thanks to all the scientists we got in touch with for this episode, including Professor Larry Young, Professor Tiffany Field, Professor Ethan Kross, Professor Sandra Langeslag, and Professor Naomi Eisenberger. Thanks to Lori Segal. A special thanks to the Zukerman family and Joseph Lavelle Wilson.
I’m Wendy Zukerman - fact you next week
[2] “Ten women and five men were recruited from the State University of New York at Stony Brook, Rutgers University, and the New York area by word of mouth and with flyers. The flyer highlighted the sentence: “Have you just been rejected in love but can’t let go?” "
[3] Pg 57 “The insular cortex regions where we found activity have been associated in other studies with physical pain and/or distress (Brooks et al. 2005; Dube et al. 2009; Treede et al. 2000). Also a large area of the anterior cingulate where we found activity is involved in pain regulation (e.g., Petrovic et al. 2002).”
[4] insular cortex and pain regulation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748680/; anterior cingulate cortex and pain regulation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017137/
[5] Physical pain sensitivity correlation w/ romantic rejection: Kross et al (2011) “Social rejection shares somatosensory representations with physical pain”
[6] “Social rejection produced greater overall MOR [µ-opioid receptor] activation compared with acceptance. … The pattern of MOR activation in the amygdala, thalamus and ventral striatum during social rejection was similar to that during physical pain, supporting the hypothesis that responses to social rejection and physical pain are regulated by overlapping neuronal pathways.” [sci-hub]
[7] Physical pain sensitivity and love: Love as a Modulator of Pain (review paper); also notes studies that suggest the perception of physical pain can be decreased by looking at photos of loved ones, though some studies suggest that other distractions work as well
[8] 2019 review of social/physical pain neuro overlap and divergence: https://journals.sagepub.com/doi/10.1177/1089268019857936
[9] “growing body of literature suggesting a possible overlap in the neural circuitry underlying physical and social pain” https://sanlab.psych.ucla.edu/wp-content/uploads/sites/31/2015/05/Eisenberger2012NRN.pdf (https://pubmed.ncbi.nlm.nih.gov/22551663/)
[10] “Research suggests that the reason these metaphors come so easily to us may be that social pain – the profound distress experienced when social ties are absent, threatened, damaged, or lost – is elaborated by the same neural and neurochemical substrates involved in processing physical pain ... In other words, social disconnection (and the threat thereof) hurts in a very real way because it recruits some of the same neural mechanisms that respond to physical injury” [sci-hub]
[11] Physical pain sensitivity correlation w/social rejection: Eisenberger “The neural bases of social pain“: “...when we describe experiences of social pain…we often do so with physical pain words, complaining of “hurt feelings” or “broken hearts.” In fact, this pattern has been shown to exist across many different languages and is not unique to the English language [8]”; “...the research reviewed here supports the idea that the pain of social rejection, exclusion, or loss may be more than just metaphorical by highlighting a common set of neural regions that underlie both social and physical pain.”
[12] 2017 Wang et al. How the brain reacts to social exclusion/stress [sci-hub] Regions of the insula, anterior cingulate cortex, temporal and prefrontal cortex were activated to social exclusion
[13] The present meta-analysis shows that three parts of the ACC, namely sgACC, pgACC and aMCC, are involved in social rejection and more generally in social pain. … These hypotheses have been systematically tested and the results so far are consistent with the view that social and physical pain may share similar neural underpinnings, including the anterior insula and the aMCC ( Eisenberger, 2012a ). The aMCC as a shared neural correlate for social and physical pain was mainly questioned through the different possible interpretations concerning the psychological correlates of the exclusion phase during the cyberball task.
[14] Social Pain/Rejection review - https://www.annualreviews.org/doi/10.1146/annurev-psych-010213-115146
[15] Dopaminergic reward system: see “The Mesocorticolimbic Dopamine System”
[17] Cocaine activation of VTA&VStr [ventral striatum] (“...the mesoaccumbens dopamine pathway, extending from the ventral tegmentum of the midbrain (VT) to the nucleus accumbens, appears to be the critical shared substrate of the reinforcing effects of cocaine (59, 108, 3, 86) and other addictive drugs”);
Nicotine Morphine (VTA), Amphetamine(VStr) [sci-hub]
[18] “Group activation specific to the beloved under the two control conditions occurred in dopamine-rich areas associated with mammalian reward and motivation, namely the right ventral tegmental area and the right postero-dorsal body and medial caudate nucleus” (Aron et al; authors include Fisher, Brown)
[19] “Although the sympathetic nervous system is engaged most strongly in connection with fear and anger, as well as other acute emotional states such as excitement, activation of the pituitary-adrenocortical system is thought to occur during threats appraised as more overwhelming and less readily coped with (Henry & Stephens, 1977). Activation of the adrenocortical system often accompanies chronic stress, as well as clinical depression (Gibbons, 1964; Gitlin & Gerner, 1986). SAM [sympathetic adrenal-medullary] activation is accompanied by the release of epinephrine, norepinephrine, and other catecholamines into the bloodstream, whereas HPAC [hypothalamic-pituitary-adrenocortical] activation results in the release of adrenocorticotropic hormone (ACTH) and corticosteroids (cortisol in humans and other primates). … both stress systems are often engaged during stressful encounters.” [sci-hub]
[20] “A large body of evidence demonstrates that cortisol is a hormone that is sensitive to social threats, including social evaluation, rejection, and exclusion” (p. 149)
[21] “The different results for loss and trauma mirror neuroendocrine effects of these two types of adverse events. Loss—maternal separation in nonhuman animals and bereavement in humans—is commonly associated with increased cortisol production (Irwin, Daniels, Risch, Bloom, & Weiner, 1988; Laudenslager, 1988; McCleery, Bhagwagar, Smith, Goodwin, & Cowen, 2000)” [sci-hub]
[22] 20 premenopausal women going through divorce or separation were compared to 20 nonstressed women, matched for age, ethnicity and education: “Relative to the nonstressed control subjects, the stressed women had elevated evening (9 PM) salivary cortisols, a finding that was observed on both days (mixed effects model: effect 0.44; se 0.14, p .003)”
[23] Students who experienced a recent romantic breakup were given several self-report measures and were then divided into high versus low breakup distress groups. Depression and sleep disturbance were related to breakup distress
[24] “Although sleep complaints decreased over time, the average participant in this study continued to report clinically meaningful sleep problems at V3 [visit three], which occurred nearly 8 months after entry into the study and approximately a year after participants reported having physically separated from their ex-partner.” (Krietsch et al 2014, sci-hub)
[25] Meta-analysis of >300 empirical studies of psychological stress and immune system effects: Various types of stressors are shown to have effects on immune system regulation. This meta-analysis “yields evidence of declines in natural immune response following the loss of a spouse.” [sci-hub]
[26] “Women who had been separated 1 year or less had significantly poorer immune function than a sociodemographically-matched married group, including lower percentages of NK and helper cells, poorer blastogenic responsiveness, and higher antibody titers to EBV VCA” (Kiecolt-Glaser et al 1987, sci-hub) [NK = natural killer; EBV = Epstein-Barr virus; VCA = virus capsid antigen]
[27] “The separated/divorced men... reported more recent illness, and they had significantly higher antibody titers to EBV VCA and HSV, suggesting poorer cellular immune system control over herpesvirus latency.” Those who were rejected had poorer health than those who weren’t rejected: “Among separated/divorced subjects, those who had separated within the past year and who had initiated the separation were less distressed, reported better health, and had a better performance on one functional immunological assay (EBV antibody titers) than did noninitiators.” (Kiecolt-Glaser et al 1988, sci-hub) [EBV = Epstein-Barr virus; VCA = virus capsid antigen; HSV = herpes simplex virus]
[28] Followed 32 Swedish men for 8 years: “The year of divorce and the successive three years…were characterized by high sickness rates (average 21,7 days/year, variation 19,4–26,6) compared to a reference group (average 16,6, variation 14,9-18,1).” Sickness absence lowered in next 4 years in the divorced group.
[29] “The authors … used administrative data that covers the Norwegian population for the years 1992–2008 and panel methods to investigate lags and leads of the effects of divorce, controlling for time-varying variables and time-constant unobserved factors. The results revealed that 6 years before divorce, the sickness absence rate among divorced people was at a level similar to that among those who remained married. The sickness absence rate increased in the year preceding divorce, peaked in the year of divorce, and decreased in the following year, but not to the level before divorce” [sci-hub]
[30] “Using a cross-sectional design and a sample of 1,856 recently divorced Danish citizens, multigroup confirmatory factor analysis verified the DBM´s [Divorce Burnout Model] good fit to data. … Across gender, burnout scores were found to significantly predict number of sick days and days of absence from work in the past 3 months over and above sociodemographic variables, divorce related characteristics, and depressive symptoms … In stress research, the concept of burnout is sometimes seen as representing the final stage of the stress-distress-impairment continuum and is defined as general exhaustion (Schaufeli et al., 2009) caused by prolonged exposure to severe stress (Schaufeli et al., 2009) and associated with a depressive cognitive style (Bianchi, Laurent, Schonfeld, Verkuilen, & Berna, 2018).” sci-hub
[31] The brain-heart axis in Takotsubo syndrome: “For the first time, we demonstrate hypoconnectivity of central brain regions associated with autonomic functions and regulation of the limbic system in patients with TTS. … alterations in the function of certain parts of the central nervous system may result in the onset of a TTS event in response to a stressful trigger.” [TTS = Takotsubo syndrome]
[32] See Role of Catecholamines in “Clinical manifestations and diagnosis of stress (takotsubo) cardiomyopathy” (alternate link). HPA axis in response to stress (HPA = hypothalamic-pituitary-adrenal).
[33] Takotsubo syndrome (TTS) was first described in 19901 and is generally considered to be acute heart failure with impaired regional left ventricular contractility in the absence of a corresponding coronary stenosis or plaque rupture.
[34] In Takotsubo syndrome, “The most common symptoms at presentation are chest pain and dyspnea” (difficulty breathing).
[35] “An excessive release of catecholamines also seems to have a pivotal role in the development of stress cardiomyopathy." From “Mechanisms of stress (Takotsubo) cardiomyopathy” https://www.ncbi.nlm.nih.gov/pubmed/20195267
[36] Reported time to recovery ranged from a few days to more than 2 months, from Table: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.108.767012
[37] “Whereas the condition can occur in any age group, it characteristically affects women in the sixth decade of life, although patients <50 years of age account for ≈10% of cases.17 Younger patients are more likely to be male, or have atypical takotsubo, fewer comorbidities, and acute neurological or psychiatric disorders, and to develop in-hospital complications.”
[38] “Based on the published literature about 90% of TTS patients are women with a mean age of 67–70 years, and around 80% are older than 50 years … Women older than 55 years have a five-fold greater risk of developing TTS than women younger than 55 years and a 10-fold greater risk than men.”
[39] 2014 Meta-analysis: “The in-hospital mortality rate among patients with TTC was 4.5% (95% CI 3.1 to 6.2, I2 = 60.8%).”
“In the largest TTS registry to date [2018], death rates are estimated to be 5.6% and rate of MACCE [Major adverse cardiovascular and cerebrovascular events] 9.9% per-patient year
[40] “...mortality during the acute phase in hospitalized patients is 4–5%, which is similar to the mortality seen in patients with STEMI [ST-segment-elevation myocardial infarction]. … mortality after hospital discharge is notably higher than that in aged-matched healthy populations.33 The prognosis is greatly influenced by noncardiac diseases,35 as many patients experience Takotsubo syndrome secondary to other diseases.10 Among a cohort of patients with Takotsubo syndrome in Italy, in-hospital complications were experienced by approximately 50% of patients aged ≥75 years, compared with 25% of patients aged <75 years.36 These trends were also noted in the German Takotsubo registry.37 In the largest published cohorts, the in-hospital mortality was 2.2% in Germany and Austria,38 2.6% in Italy,39 4.2% in the USA,40 6.8% in Japan,12 and 4.5% in a meta-analysis of these studies.41 Japanese investigators have reported that Takotsubo syndrome that is triggered in hospital secondary to an existing illness (such as malignancy, chronic diseases, acute diseases, and infectious diseases) is associated with significantly higher in-hospital mortality compared with onset outside hospital (odds ratio 2.02, 95% CI 1.43–2.85).” [sci-hub]
[41] “Takotsubo syndrome (TTS) presents as an acute coronary syndrome (ACS) characterized by severe left ventricular (LV) dysfunction that typically recovers spontaneously within days or weeks.” … “transient apical left ventricular ballooning”
[42] “The cardiologists from the Hiroshima City Hospital originally proposed the term tako-tsubo-like left ventricular dysfunction, because the typical shape on end-systolic left ventriculogram resembles a tako-tsubo (octopus trap) with a round (akinetic) apex and narrow (hyperkinetic) base.”
[43] "Reported stressors can include emotional triggers such as bereavement, gambling and financial losses, arguments, domestic abuse, anxiety related to public speaking and fear, including anticipated fear of medical procedures; whilst physical triggers include pain, sepsis, respiratory failure, post-surgical and malignancy." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8733363/
[44] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768342/ “To the best of our knowledge, this is the first report of takotsubo cardiomyopathy triggered by wasabi consumption.”
[45] E.g., “The defining quality of habitual responses, on the other hand, is that a history of reinforcement means that the learned response is elicited relatively automatically when the associated cue is encountered”
[46] “The current framework [of depressive rumination] suggests that habits can be broken by altering or avoiding exposure to the cues that trigger habit performance”
[47] “Daily life exposes people to various cues that trigger unwanted habits. … A successful strategy for controlling strong temptations, … involved limiting exposure to the hot stimulus properties that elicit automatic, impulsive responses. Thus, participants inhibited their strong affective impulses by removing themselves from the tempting stimulus.”
[48] “The results showed that participants ate more popcorn in the cinema context as compared with the meeting room context, supporting the hypothesis that environmental cues trigger habitual behaviour.” [sci-hub]
[49] “Reactivity to smoking-related cues may be an important factor that precipitates relapse in smokers who are trying to quit. … The meta-analysis revealed that several brain areas show consistently greater activation in response to smoking cues than neutral cues, and that these areas are located primarily within the extended visual system of the occipital, inferior temporal, and posterior parietal lobes, and in the cingulate gyrus and prefrontal cortex”
[50] “Negative reappraisal decreased love feelings and made participants feel more unpleasant. Love reappraisal [reappraisal of love feelings] did not change how in love or pleasant/unpleasant participants felt. Distraction did not change love feelings, but made participants feel more pleasant.” Note: this method is not exclusive - studies have found other potential methods to cope with break-ups like managing beliefs and expectancies about personal control
[51] “To this aim, in Study 4, we considered participants’ narratives of heartbreak in terms of the degree to which they conveyed a sense of self-growth relative to self-deterioration. We dubbed this variable narrative “self-transformation,” noting that more securely attached individuals tended to construe their heartbreak experiences as a springboard for self-growth, rather than leading to the emergence of a character flaw or deficit.”
[52] “Multilevel analyses revealed that external control beliefs were higher in but not beyond the first year after separation from a partner. Internal and total control beliefs increased gradually in the years after separation. … findings point toward stress-related growth of perceived control after some relationship losses–especially separation and the death of a partner.”
[53] “Participants were 155 undergraduates who had experienced the dissolution of a relationship in the past 6 months. Results confirmed the hypotheses that growth would be related to ending a relationship low in self-expansion and that the relationship between these variables would be mediated by experiencing more rediscovery of the self, less loss of self, and more positive emotions following dissolution.”
[54] Original study: “A sample of 192 university students who had experienced a recent breakup of a romantic relationship was divided into high versus low score groups based on the Breakup Distress Scale. Females had higher Breakup Distress Scale scores. The group who had high Breakup Distress Scale scores reported having less time since the breakup occurred, did not initiate the breakup, reported that the breakup was sudden and unexpected, felt rejected and betrayed, and had not yet found a new relationship.” [full-text]
[55] After male voles separated from monogamous partner: Partner loss increased circulating corticosteroid and adrenal weight. Stress behaviors went away with antagonist.
[57] In monogamous prairie voles: “Long-term separation erodes enhanced partner-associated dopamine release” … We found that partner seeking, anticipation, and interaction resulted in more accumbal dopamine release than the same events directed toward a novel vole. Further, partner-associated dopamine release decreased after prolonged partner separation.
[58] “A total of 87 currently single participants (25 males, 62 females) who recently experienced relationship dissolution were randomly assigned to one of three writing conditions (negatively-focused, positively-focused, and neutral) to determine writing’s impact on change in emotions. As hypothesized, participants in the positive writing condition increased in positive emotions from pretest to immediate posttest compared to both the negative writing and neutral writing conditions. There were no differences between conditions in the experience of negative emotions.”
[59] “Seventy-two male and 73 female undergraduates were randomly assigned to an experimental group, in which they wrote expressively about a relationship breakup, or to a control group, in which they wrote in a non-emotional manner about impersonal relationship topics. Control participants reported short-term increases in upper respiratory illness (URI) symptoms, tension and fatigue, whereas experimental participants did not.”
[60] “One-hundred and six nonstudent adults took part in a 4-day online daily diary study … In order to be included, participants must have experienced a romantic relationship dissolution within the past 6 weeks … individuals reported reduced emotional distress to the extent that they had used more, versus fewer, redemptive narratives the day before (a lagged effect), but only at the end, not the beginning, of the study” [sci-hub]
[61] “The statistical population included all students who experienced a romantic break-up in Iran in 2020, aged 18–38 years. … A group was then randomly selected and divided into three groups: the first experimental group (transdiagnostic group therapy) included 15 participants; the second experimental group (emotional schema therapy) consisted of 15 participants; and the third group was the control group with 15 participants. The experimental groups received ten 90-min group therapy sessions. … According to the results of repeated measures ANOVA, there were significant differences between the experimental and control groups (p < 0.05) in the post-test scores of distress tolerance and cognitive emotion regulation strategies.”
[62] “The statistical population consisted of all females, aged 18-35 years, who experienced a romantic relationship breakdown in Isfahan, Iran, in 2021. Thirty participants were selected via available sampling and randomly divided into control and experimental groups. The experimental group participated in 10 sessions of emotion focused therapy (90 minutes per session)... The results indicated significant differences in the mean scores of mental pain, experiential avoidance, and forgiveness between the experimental and control groups (P<0.001).”
[63] Small case studies -
1) three participants (also Iran): “The results showed that compassion-focused therapy has a significant effect on the reduction of Depression and mental Rumination.” (after a romantic breakup)
2) “This preliminary study explored the efficacy of a three-session protocol of Acceptance and Commitment Therapy (ACT) focused on repetitive negative thinking (RNT) for the treatment of complicated breakup grief in three women. … All three participants showed clinically significant changes in repetitive negative thinking, experiential avoidance, cognitive fusion, and valued living.”