Showing papers in "Annals of Behavioral Medicine in 1998"

Efficacy of an individualized, motivationally-tailored physical activity intervention

Abstract: This study compared the efficacy of two low-cost interventions for physical activity adoption. Sedentary (N=194) adults recruited through newspaper advertisements were randomized to receive either a motivationally-matched, individually-tailored intervention (IT) or a standard self-help intervention (ST). Assessments and interventions were delivered by repeated mailings at baseline, one, three, and six months. Participants were assessed regarding current physical activity behavior, motivational readiness to adopt regular physical activity, and psychological constructs associated with physical activity participation (e.g. self-efficacy, decisional balance). Repeated measures analyses of variance (ANOVAs) revealed significant increases in physical activity participation between baseline and six months for both groups with a significantly greater increase among IT participants. The IT group outperformed the ST group on all primary outcome measures: (a) minutes of physical activity per week, (b) reaching Centers for Disease Control and American College of Sports Medicine (CDC/ACSM) recommended minimum physical activity criteria, and (c) achieving the Action stage of motivational readiness for physical activity adoption. Both groups showed significant improvement between baseline and six months on the psychological constructs associated with physical activity adoption (e.g. self-efficacy), with no significant differences observed between the treatment groups. Utilizing computer expert systems and self-help manuals to provide individually-tailored, motivationally-matched interventions appears to be an effective, low-cost approach for enhancing physical activity participation in the community.

Accuracy of smokers' risk perceptions

Abstract: In response to disagreements about the extent to which smokers recognize the full risk of smoking-induced illness, an attempt was made to review all articles that have investigated smokers' risk perceptions. These diverse studies are grouped here into four categories, depending on the type of risk judgment solicited by researchers. This grouping shows that the apparent underestimation or overestimation of risk depends on how risk perceptions are assessed. No single conclusion about the accuracy of smokers' numerical risk estimates is possible since the accuracy depends entirely on the health outcome rated (e.g. lung cancer versus all deaths due to smoking). With other types of risk questions, smokers consistently acknowledge that smoking increases health risks, but they judge the size of these increases to be smaller and less well-established than do non-smokers. Finally, smokers minimize the personal relevance of the risks; they do not believe that they are as much at risk as other smokers of becoming addicted or suffering health effects. The accumulated data indicate that smokers continue to minimize their personal health risks.

Body images and obesity risk among Black females: A review of the literature

Abstract: The prevalence of obesity among Black women has reached epidemic proportions. Some researchers have suggested that the body images of Black females may contribute to their high risk for obesity by inhibiting motivation for weight control. While a number of empirical studies have examined the body images of Black females, findings are complex and at times, inconsistent. For example, some studies show that Black females consider overweight bodies more attractive, while other studies show that Black females prefer normal-weight bodies. Divergent findings may be due, in part, to the multidimensional nature of body image. Inconsistencies may also be due to differences between the Black females sampled. Methodological problems, including the use of measures that have been validated among Black females, the use of various weight-for-height standards, and the inconsistent analyses of or lack of physiological data, also may contribute to conflicting results. This review addresses the complexity of body image findings among a heterogeneous Black female population and the relationship between their body images and obesity risk. Implications for effective obesity treatment programs and suggestions for improvements in future body image studies are also discussed.

Anxiety and coronary heart disease: A synthesis of epidemiological, psychological, and experimental evidence

Abstract: The purpose of this review is to examine the epidemiological, psychological, and experimental evidence for an association between anxiety and coronary heart disease (CHD). Papers published during the years 1980–1996 on anxiety and CHD and relevant publications from earlier years were selected for this review. Epidemiologic evidence suggests that anxiety may be a risk factor for the development of CHD. Chronic anxiety may increase the risk of CHD by: (a) influencing health behaviors (e.g. smoking); (b) promoting atherogenesis (e.g. via increased risk of hypertension); and (c) triggering fatal coronary events, either through arrhythmia, plaque rupture, coronary vasospasm, or thrombosis. Electrophysiologic evidence is particularly compelling: anxiety appears to be associated with abnormal cardiac autonomic control, which may indicate increased risk of fatal ventricular arrhythmias. The strength, consistency, and dose-response gradient of the association between anxiety and CHD, together with the biologic plausibility of the experimental evidence, suggest that anxiety may contribute to risk of CHD and that the relationship warrants further investigation.

Anger inhibition, cardiovascular recovery, and vagal function: A model of the link between hostility and cardiovascular disease

Abstract: A model of the association between hostility and cardiovascular disease (CVD) is proposed based upon anger inhibition, slow cardiovascular recovery, and low parasympathetic activity (vagal tone). This model is opposed to the more conventional model that emphasizes anger expression, cardiovascular reactivity, and high sympathetic tone. We argue that in social reality, incidences of anger inhibition outnumber incidences of anger expression to a great extent, irrespective of preferred expression style. Moreover, slow cardiovascular recovery, rather than high reactivity, may be the mechanism underlying the CVD risk associated with anger inhibition. Both anger inhibition and slow cardiovascular recovery are associated with a persistently low vagal tone. Thus, the anger inhibition/vagal inhibition model seems more consistent with the actual nature of anger in daily life and with the known cardiovascular control mechanisms. The model may better account for the chronic pathophysiological state that is believed to lead to CVD. Importantly, an experimental inhibition/recovery paradigm might also allow to test potential behavioral and cognitive accelerators of cardiovascular recovery. As an example of an important socially-mediated health risk that may be elucidated using the anger inhibition/vagal inhibition model, we discuss Black-White differences that have been found in CVD.

Prevalence of binge eating disorder, obesity, and depression in a biracial cohort of young adults

Abstract: This article examined the prevalence of binge eating disorder (BED), obesity, and depressive symptomatology in a biracial, population-based cohort of men and women participating in a longitudinal study of cardiovascular risk factor development. The Revised Questionnaire on Eating and Weight Patterns was used to establish BED status among the 3,948 (55% women, 48% Black) participants (age 28–40 years). Body mass index (BMI: kg/m2) was used to define overweight (BMI>-27.3 in women and ≥27.8 in men). Depressive symptomatology was assessed with the Center for Epidemiologic Study Depression Scale. Prevalence of BED was 1.5% in the cohort overall, with similar rates among Black women, White women, and White men. Black men had substantially lower BED rates. Depressive symptomatology was markedly higher among individuals with BED. Among overweight participants, BED prevalence (2.9%) was almost double that of the overall cohort. There were no differences in BED rates between overweight Black and White women. Thus, BED was common in the general population, with comparable rates among Black women, White women, and White men, but low rates among Black men. Obesity was associated with substantially higher prevalence of BED. Treatment studies that target obese men and minority women with BED are indicated.

Personality and coronary heart disease: The Type D Scale-16 (DS16)

Abstract: Clinical diagnoses of depression, self-reported negative emotions, and personality traits have been associated with both the development and progression of coronary heart disease (CHD). This article focusses on negative affectivity (the tendency to experience negative emotions) and social inhibition (the tendency to inhibit self-expression in social interaction) in CHD patients. Two independent samples of patients with CHD were included in this study. Both empirical and internal-structural criteria were used to devise a brief self-report measure comprising an eight-item negative affectivity and an eight-item social inhibition scale in Sample 1 (N=400). These scales were internally consistent (α=.89 and .82), stable over time (three-month test-retest reliability=.78 and .87) and were validated against standard personality scales. CHD patients with a “distressed” personality (Type-D) report high levels of negative affectivity and social inhibition; accordingly, this self-report measure was termed Type-D Scale-16 (DS16). Previous research showed that Type-D was associated with cardiac events and incidence of cancer in patients with CHD. Type-D as measured by the DS16 was associated with depressive affect and symptoms, stress, poor self-esteem, dissatisfaction with life, and low positive affect in Sample 2 (N=100) of the present article. It is concluded that research on CHD should focus on affective disorder, specific negative emotions, and global personality traits, and that the DS16 is a practical, sound research tool that can be used to assess Type-D.

Reliability of the timeline follow-back sexual behavior interview.

Abstract: The reliability of self-reported sexual behavior is a question of utmost importance to human immunodeficiency virus (HIV) prevention research. The Timeline Follow-Back (TLFB) interview, which was developed to assess alcohol consumption on the event level, incorporates recall-enhancing techniques that result in reliable information. In this study, the TLFB interview was adapted to assess HIV-related sexual behaviors and their antecedents, and its reliability was assessed. The interview was administered to 110 participants (46% women, M age = 19.7; range = 18-41), and 58 participants who reported sexual behavior during the previous three months returned one week later for a second interview. Test-retest intraclass correlations (rho) from the TLFB protocol showed that all sexual behaviors were reported reliably (rho range = .86 to .97, median = .96). Bootstrapping, a nonparametric statistical technique, was used for significance testing in the reliability analyses. Reliability was equivalent across each of the three months assessed with the TLFB and was equivalent to conventional assessment methods (i.e. single-item questions). These findings show that the TLFB sexual behavior interview provides reliable reports of sexual behavior over three months and yields event-level data that are extremely valuable for sexual behavior and HIV-prevention research.

Characteristics of successful and unsuccessful dieters: An application of signal detection methodology,

Abstract: Signal detection methods were used to identify predictors of successful weight loss in 177 mildly to moderately overweight women and men assigned to one of two weight-loss programs. Predictors included initial demographic, physiological, behavioral, and psychosocial characteristics, and program type (e.g. diet-only and diet-plus-exercise). Successful weight loss was defined as a loss of at least two units of body mass index at one year. Four subgroups were identified. Participants in the diet-plus-exercise program who were initially more satisfied with their bodies and did not have a history of repeated weight loss were most likely to succeed (63% succeeded). In contrast, participants assigned to the diet-plus-exercise program who were either extremely dissatisfied with their bodies or who had a history of repeated weight loss were at similar risk for failure as participants in the diet-only program (only 26% to 35% succeeded). The results underscore the potential utility of exploring these subgroups further to inform the development of new treatment strategies to increase the likelihood of success.

A longitudinal study of work load and variations in psychological well-being, cortisol, smoking, and alcohol consumption

Abstract: The effects of variations in work load (indexed by paid work hours) on psychological well-being, cortisol, smoking, and alcohol consumption were examined in a sample of 71 workers (44 women, 27 men) in the retail industry. Measures were obtained on four occasions over a six-month period, and assessments were ranked individually according to hours of work over the past seven days. Job strain (demand/control) and job social support were evaluated as potential moderators of responses. Paid work hours ranged from a mean of 32.6 to 48.0 hours per week, and ratings of work-home conflict and perceived stress varied across assessments. Salivary cortisol was inversely associated with job strain and did not vary across sessions. Female but not male smokers consumed more cigarettes during periods of long work hours, and self-reported smoking and cotinine concentrations were greater among smokers with higher nicotine dependency scores. Men but not women with poor social supports consumed more alcohol as work hours lengthened. These data indicate that health behaviors are affected only to a limited extent by variations in work load. Results are discussed in the context of adaptation to work and the pathways linking stressful experience with health risk.

Problems and prospects for the social support-reactivity hypothesis.

Abstract: Social support and integration have been linked to health and longevity in many correlational studies. To explain how social relationship might enhance health, investigators are examining the effects of social support on physiological processes implicated in disease. Much of this research focuses on testing the social support-reactivity hypothesis, which maintains that social support enhances health by reducing psychobiologic reactivity to stressors. This article identifies the basic assumptions, problems, and prospects of this research endeavor. The major problems discussed include: (a) inconsistent findings across studies; (b) unidentified cognitive and emotional mediators; (c) individual differences in response to social support: and (d) a lack of experimental studies on the role of social support in adjustment to chronic stress. Besides raising consciousness about these problems, I offer ideas for advancing research in this area.

The effects of marital transitions on changes in physical activity: Results from a 10-year community study

Abstract: The potential effects of making a marital transition on subsequent physical activity were evaluated across a ten-year period in a population-based sample of 302 women and 256 men ages 25 to 75 years. Subjects completed a structured interview at five timepoints throughout the ten-year period during which they reported on their physical activity level as well as marital status. The transition from a married to a single state did not affect physical activity relative to remaining married when analyses of either slopes or mean values were used. In contrast, the transition from a single to a married state resulted in significant positive changes in physical activity relative to remaining single throughout the study period when physical activity slopes, though not means, were compared. The results suggest that marriage may potentially set the stage for natural changes in physical activity that could be capitalized on through appropriate intervention, but additional research is needed to verify this in light of the inconsistent pattern of findings.

Compliance with inhaled medications: The relationship between diary and electronic monitor

Abstract: Self-report is a frequently-used method of assessing compliance with prescribed medications in patients with chronic illnesses. Most researchers agree, however, that self-report misrepresents patient adherence to regimen prescription. In this randomized, controlled study evaluating inhaler medication compliance, diary data was compared to electronic monitoring in 55 adults with asthma. Subjects randomized to the treatment group received a six-week self-management program. An electronic monitor, the MDI Chronolog, was used in this study to assess inhaler use. The MDI Chronolog records the date and time of each inhaled activation. The self-report measure used was a daily asthma diary. Subjects were asked to use their inhaled medications as usual and record the date and time they administered their medication over a one-week period.

Contribution of behavior therapy and biofeedback to laxative therapy in the treatment of pediatric encopresis

Abstract: A model incorporating physiological, behavioral, and psychological parameters are presented to explain the maintenance and consequences of pediatric encopresis. It was hypothesized that the more comprehensive a treatment in addressing these parameters, the more efficacious it would be and the more children it would benefit. Eighty-seven children between the ages of 6 and 15 with the primary complaint of encopresis were randomly assigned to one of three treatments: (a) Intensive Medical Care (IMC), receiving enemas for disimpaction and laxatives to promote frequent bowel movements; (b) Enhanced Toilet Training (ETT), using reinforcement and scheduling to promote response to defecation urges and instruction and modeling to promote appropriate straining, along with laxatives and enemas; or (c) Biofeedback (BF), directed at relaxing the external anal sphincter during attempted defecation, along with toilet training, laxatives, and enemas. Three months following initiation of treatment, ETT and BF produced similar reductions in soiling/child (76% and 65%) that were superior (p's<.04) to IMC (21%). ETT significantly benefited more children than the other two treatments, employing fewer laxatives and fewer treatment sessions at a lower cost. Consistent with the presented model, reduction in soiling was associated with an increase in bowel movements in the toilet, reduction in parental prompting to use the toilet, and defecation pain. These results demonstrate that ETT should be used routinely with laxative therapy in the treatment of chronic encopresis.

Psychosocial stress moderates the relationship of cancer history with natural killer cell activity.

Abstract: Data suggest that both cancer history and psychosocial stress may be associated with reductions in natural killer cell activity (NKA) Therefore, we tested whether individual differences in cancer history, chronic/perceived stress, and their interactions would be associated with decreased levels of NKA We tested these hypotheses in 80 spouse caregivers of victims of Alzheimer’s Disease (AD) (persons known to report high levels of psychosocial stress) and in 85 age- and sex-matched spouses of non-demented controls Participants were assessed at study entry (Time 1) and 15–18 months later (Time 2) Individuals with cancer histories (N=43) had not been treated with immune altering medications within the last year At both Times 1 and 2, cross-sectional main effects were weak or absent for cancer history, perceived stress (eg high hassles, low uplifts), and caregiver status; however, interactions occurred between cancer history and perceived stress, such that persons with cancer histories and high hassles/low uplifts had the lowest NKA values (p<05) These results occurred even after controlling for age, gender, beta-blocker use, hormone replacement therapy, alcohol, and exercise At Time 1, an interaction also occurred between caregiver status and cancer history—caregivers with cancer histories had lower NKA than did controls with cancer histories and caregivers/controls without cancer histories (p<05) At Time 2, this interaction only showed a trend (p<08), primarily because caregivers with cancer histories experienced increases in NKA (p<05) from Time 1 to Time 2, whereas in the other three groups NKA did not change Importantly, in caregivers with cancer histories, high perceived stress at Time 1 predicted low NKA at Time 2 (p<05) This research suggests that the combinations of biological vulnerabilities and chronic/perceived stress may have interactive effects resulting in reduced NKA

Patients' pretreatment expectations of chemotherapy-related nausea are an independent predictor of anticipatory nausea

Abstract: Based on extensive research with animals, classical conditioning theorists have come to regard contingency as the primary factor in the development of conditioned responses. However, recent experimental work with humans has suggested the possibility that participant expectations may also directly contribute to the development of conditioned responses. To date, this phenomenon has not been investigated in clinical settings. Anticipatory nausea (AN) in chemotherapy patients, widely viewed as the best established example of classical conditioning in clinical medicine, provides an opportunity to examine the contributions of patient expectations to the development of a conditioned response outside the laboratory. The present study of 59 breast cancer patients supported the hypothesis that pretreatment patient expectations make a significant (p<.03) contribution to the development of AN after statistically controlling for the strongest conditioning predictor, contingency. These data imply that patient expectations should be considered when evaluating conditioned responses to aversive medical treatments.

Recruitment for complementary/alternative medicine trials: who participates after breast cancer.

Abstract: Background: Despite the popularity and widespread practice of complementary/alternative medicine (CAM), researchers may face problems accruing patients to randomized clinical trials, considered the gold standard of biomedical research. Strict exclusion criteria and barriers to participation may limit accrual. Inadequate numbers of subjects decrease the ability of studies to detect an effect that exists and generalize their findings. This article describes the recruitment experience of a CAM trial, details reasons for non-participation and contrasts participants and non-participants on demographic, clinical, and treatment-related variables. Methods: Women who were Houston area residents and spoke English, had primary breast cancer (excluding Stage IV), and were 1 to 30 months posttreatment with no steroids, tamoxifen, substance abuse, psychiatric or heart disease, or immune deficiency were eligible. The enrollment process involved three contacts (i.e. introductory letter and brochure, telephone calls, and reminder post cards). Potential participants were told that the study would require blood samples (30cc) to assess immune function; psychosocial measures to assess emotional well-being, quality-of-life, social support, and coping strategies; and possible assignment to six weekly support or imagery sessions. Factors influencing recruitment and reasons for non-participation were assessed by stratified analysis and multivariate logistic regression. Results: Of 158 eligible participants, 30% (N=47) consented to participate. Primary reasons for non-participation included work/childcare (33.3%), transportation/travel (30.6%), and lack of interest (24.3%). Participants were more likely to be 40–54 years of age versus younger or older, divorced/separated, and able to pay some/all medical expenses. Divorced or separated women appeared to be more likely to participate, regardless of financial status. Conclusion: Researchers must assess the impact of exclusion criteria on accrual and recognize the special needs of their target population. Although age, marital status, and pay status were the strongest predictors of participation, these factors are not amenable to intervention. Based on this study, researchers might boost accrual by providing interventions available during the day and evening to accommodate working women, child care services, transportation, or reimbursement for travel costs.

Effects of preparatory videotapes on self-efficacy beliefs and recovery from coronary bypass surgery

Abstract: This study evaluated the relative effects of three experimental videotapes that involved different approaches for preparing coronary artery bypass graft (CABG) patients for surgery and the inhospital recovery period. One of the tapes conveyed information via a health care expert only. The other two featured the same health care expert and also included clips of interviews with patient models. These latter two tapes differed in the extent to which they portrayed the recovery period as a steady, forward progression or as consisting of “ups and downs.” Two hundred fifty-eight male CABG patients were randomly assigned to view one of the three videotapes on the evening prior to surgery or to a control condition. Overall, patients who viewed any of the videotapes felt significantly better prepared for the recovery period, reported higher self-efficacy for using the incentive spirometer and for speeding their recovery, performed more repetitions with their incentive spirometer each time they used it postoperatively, had shorter intensive care unit stays, and were released from the hospital more quickly than patients in the control condition. There was also evidence that patients’ self-efficacy beliefs for speeding recovery directly mediated the effects of the videotapes on length of stay both in the intensive care unit and in the hospital.

The impact of a brief problem-solving training intervention for relatives of recently diagnosed breast cancer patients

Abstract: Previous studies have found high levels of psychological distress in women who have a family history of breast cancer. We evaluated a brief Problem-Solving Training (PST) intervention designed to reduce distress among women with a first-degree relative recently diagnosed with this disease. Participants were randomly assigned to either the PST group (N=144) or a General Health Counseling (GHC) control group (N=197). At baseline, these groups did not differ on any sociodemographic, risk factor, or psychological distress variables. We evaluated the impact of PST, relative to GHC, at the three-month follow-up assessment using a 2 (treatment group)×2 (time of assessment) mixed factor analysis of variance (ANOVA). Although there were significant decreases in both cancer-specific and general distress in both the PST and GHC groups, the magnitude of these decreases did not differ. However, when PST participants were divided into those who regularly practiced the PST techniques and those who did not, significant differences emerged. Participants who regularly practiced the PST techniques had significantly greater decreases in cancer-specific distress [Impact of Event Scale (IEs) intrusion and avoidance subscales] compared to infrequent practicers and GHC participants. Effects on general distress were not found. Additional studies are needed to identify ways to promote the practice of PST techniques and to evaluate other psychosocial interventions for female relatives of breast cancer patients.

Correlates of self-efficacy expectation and prediction of walking behavior in cardiac surgery elders,

Abstract: As the number of elderly patients undergoing cardiac surgery (coronary artery bypass and valve replacement) continues to increase, evidence is growing that they can do so with improved health status, functional status, longevity, and life quality. In this article, we used self-efficacy theory to explore one of the most common recovery behaviors--walking various distances. In preoperative data collected in-hospital through data collection at one, two, three, six, and twelve months postoperatively, we explored: (a) the trajectories of self-efficacy expectation (SEE) and self-reported (SR) behavior performance over the first postoperative year; (b) the relationships between SEE and SR behavior; (c) predictors of SEE; and (d) using hierarchical multiple regression, identified predictors of SR behavior at each point of time. The sample (N = 199) was primarily male (76%) with a mean age of 75.8 years. SEE and SR behavior increased over time though with different trajectories; at all points in time, females had lower scores. Correlations between SEE and SR behavior were statistically significant (r values ranging from 0.67 to 0.89; p < .01) for both males and females. Predictors of SEE and SR identified were a mix of physiologic and psychologic constructs. The amount of explained variance in SR behavior scores ranged from a low of 23% at one month to a high of 64.7% at six months. The gender differences sustained one year after cardiac surgery are striking; elder females may need targeted interventions to enhance recovery.

A case for the usefulness of laboratory social stressors.

Abstract: Althrough laboratory, stress research is a popular and vibrant area of research activity, there is surprisingly little evidence that laboratory stress models are clinically useful (i.e. that they can explain and predict the development of disease). This article summarizes evidence that the usefulness of lab stress research can be improved with the use of social stressors. Two lines of evidence are presented in support of this argument: (a) studies comparing physiological reactivity to different lab stressors with ambulatory activity, and (b) a meta-analysis of investigations of cortisol responses to laboratory stressors. Further issues of importance in understanding social stressors are gender differences and the vulnerability (i.e. weak reliability) of social stressor impact to relatively small changes in the experimental protocol itself.

The effects of the social environment on stress-related cardiovascular activation: Current findings, prospects, and implications

Abstract: Social relationships have been shown to be health-protective and to improve cardiovascular disease prognosis. One of the mechanisms by which social relationships may alter health status is through altering patterns of neuroendocrine or hemodynamic responding to ongoing activity. For example, research with non-human primates suggests that disrupted social relationships may increase cardiovascular risk through their effects on sympathetic nervous system activation. In humans, a number of recent reports have shown that the presence of an affiliative companion can reduce cardiovascular activity during psychologically challenging tasks, results which are consistent with this proposed mechanism of effect. We review the recent human literature which has examined the effects of the social environment on stress-related cardiovascular activity. Although findings in this literature are generally consistent, recent anomalous results are reviewed which shed light on some of the context-dependent effects of social affiliation. Additional areas for further investigation are examined, including possible mechanisms for explaining these social affiliation effects, individual differences which may moderate these effects, and emerging methodological advances for examining how these effects may generalize to the natural environment.

Perceptions of spouse dominance predict blood pressure reactivity during marital interactions.

Abstract: Cardiovascular reactivity (CVR) has been identified as a potential mechanism linking a variety of psychosocial processes to the development of cardiovascular disease. Although the effects of hostile and supportive social stimuli on CVR have been studied extensively, less in known about the effects of a second major dimension of social relations—dominance versus submissiveness. In the present study, 45 married couples participated in an interaction task involving the assertion of differing opinions. Subjects also provided ratings of their typical level of dominance versus submissiveness in relation to their spouse. Consistent with predictions derived from related conceptual models of psychological determinants of CVR, blood pressure reactivity was positively associated with perceptions of the spouse as dominant. At the highest level of perceived spouse dominance, CVR was attenuated, again consistent with prediction. Results are discussed in terms of the usefulness of conceptual models of interpersonal relations and motivation as guides in studying the social determinants of CVR, as well as the value of marital interactions as a context for understanding CVR.

Social evaluation influence on cardiovascular response to a fixed behavioral challenge: effects across a range of difficulty levels.

Abstract: Participants performed five memory tasks--ranging in difficulty from very low to very high--under public or private conditions. The publicity and difficulty variables interacted to determine systolic pressure and heart rate responses during performance. Where performance was public, responsiveness on the parameters increased with difficulty to a point and then dropped; where performance was private, responsiveness was relatively low at all difficulty levels. Diastolic pressure responses were configured similarly, although in that case the interaction was not reliable. Findings corroborate and extend results from a previous study, argue against some explanations of those results, and strengthen the case for a recent active coping analysis of cardiovascular audience effects. Findings also strengthen the case for a broader model of effort and cardiovascular response, which has potential for advancing our understanding of a range of phenomena and processes related to behavior and health.

The comparison of individuals with recurrent tension-type headache and headache-free controls in physiological response, appraisal, and coping with stressors: A review of the literature

Abstract: It is widely accepted that stress plays an important role in the experience of tension-type headache. This article reviews the literature in which individuals with recurrent tension-type headache are compared to headache-free controls in the experience and appraisal of stress, psychophysiological response to stress, and coping with stress. A modified and extended version of the transactional model of stress as it might apply to tension-type headache is used to organize the relevant literature. In summary, there is evidence to suggest that individuals with recurrent tension-type headache experience more stressful events and are more sensitive and have a lower threshold to pain. There are some suggestions that headache sufferers may use different coping strategies for stress and pain. There is little evidence of differences in physiological responses to stressful events. The shortcomings of this body of literature are addressed and directions for future research are identified.

Cardiovascular and behavioral response to social confrontation: Measuring real-life stress in the laboratory

Abstract: Laboratory investigations of cardiovascular reactivity to mental stress often ignore concomitant differences in cognitive, affective, and behavioral responses that are commonly observed among study participants. To provide a more systematic laboratory methodology to examine relations among cardiovascular, behavioral, and self-report measures of cognitive and affective responses to stress, we developed and tested a social confrontation procedure involving standardized interactions during two scenes. Results of three investigations are presented to illustrate the utility of the social confrontation procedure. In the first two studies, this multidimensional assessment strategy produced results which may foster research projects that bridge separate areas of psychological inquiry. In one application, persons with hypertensive parents, in contrast to persons with normotensive parents, exhibited characteristic negative behavioral responses during both interactions as well as the more commonly-observed exaggerated blood pressure reactions. In the other study, students from less functional families (regarding cohesion and adaptability) were shown to exhibit exaggerated blood pressure reactions in addition to their commonly-reported negative cognitive and behavioral coping styles. Finally, a third study examined how a simple instructional set regarding the expression or suppression of anger influenced participants' responses. Significant differences were observed across response domains, with anger expression resulting in a more intense response than anger suppression. In sum, the social confrontation procedure represents an important methodological development for exploring the relation between response domains, the relation between cardiovascular response to stress and psychosocial risk for cardiovascular disease, and the physiological and behavioral distinction between anger expression and anger suppression.

Cognitive-behavioral intervention effects on mood and cortisol during exercise training

Abstract: The purpose of the present study was to assess the effect of a time limited cognitive-behavioral stress management program (CBSM) on mood state and serum cortisol among men and women rowers (N=34) undergoing a period of heavy exercise training. After controlling for life-event stress (LES), CBSM was hypothesized to reduce negative mood state and cortisol among rowers during a period of heavy training; mood and cortisol changes over the intervention period were hypothesized to be positively correlated. LES was positively associated with negative affect at study entry. After covariance for LES, rowing athletes randomly assigned to the CBSM group experienced significant reductions in depressed mood, fatigue, and cortisol when compared to those randomized to a control group. Decreases in negative affect and fatigue were also significantly associated with cortisol decrease. These results suggest that CBSM may exert a positive effect on athletes' adaptation to heavy exercise training.

Clarification of the conceptualization and measurement of denial in psychosocial oncology research

Abstract: Denial represents an important area of study in individuals with cancer. It may be related to recognizing symptoms, seeking medical help, psychological adjustment to diagnosis and illness, and perhaps progression of the disease. However, denial has been defined theoretically and measured in a variety of ways. These differences are due to a lack of consensus as to whether denial is unconscious versus conscious, a trait versus a state, an indication of psychological disturbance versus a normal response to a life-threatening disease, or a broad versus a narrow concept. In addition, there is a lack of congruence between theoretical definitions and the operational definitions used in empirical studies investigating denial in the context of cancer. This inconsistency may be responsible for the mixed findings concerning the importance and function of denial in individuals with cancer. In this article, the ways in which denial has been conceptualized and operationalized are examined, and an overview of the research examining denial in cancer patients is provided. We recommend that future studies provide explicit definitions of denial, use multiple measures assessing different modalities and outcomes, measure denial at several times over the course of illness, and take into account aspects of the individual’s situation to ensure that denial is not identified erroneously.

Social relationships and the progression of human immunodeficiency virus infection: A review of evidence and possible underlying mechanisms

Abstract: We review studies examining the quality and quantity of social relationships as potential risk factors for differential progression of human immunodeficiency virus (HIV) infection. Several well-conducted prospective studies suggest that the health effects associated with the presence of supportive social relationships vary according to disease stage and mode of transmission. For gay of bisexual males in the early stages of infection, the presence of supportive social relationships appears to be a risk factor for accelerated disease progression. For individuals in the later stages of infection and those who acquire HIV via intravenous drug use or transfusion, supportive social relationships appear to be associated with health protective effects similar to those observed in other disease settings. We consider a variety of potential explanations for accelerated disease progression in gay men with extensive networks of personal relationships.

The relation of hostility to lipids and lipoproteins in women: Evidence for the role of antagonistic hostility.

Abstract: We examined the relation of antagonistic, neurotic, and cynical hostility to lipids and lipoproteins in 77 healthy women (aged 18–26) selected for having high (>17) or low (<12) scores on the Cook-Medley Hostility (Ho) scale. Fasting lipids were determined during the luteal phase of the menstrual cycle for oral contraceptive (OC) non-users (N=41), and during pills 15–21 for OC users (N=36). Factor scores for antagonistic and neurotic hostility were derived from a principal component of the Buss-Durkee Hostility Inventory, Spielberger's Anger Expression, and the NEO-Personality Inventory. High Ho scores were significantly associated with higher cholesterol. Antagonistic hostility significantly predicted cholesterol, low density lipoprotein cholesterol, triglycerides, and the ratio of cholesterol to high density lipoprotein cholesterol, with higher antagonistic hostility scores associated with higher levels. Neurotic hostility did not predict lipids. Results suggest a potential pathophysiological mechanism that may contribute to the association between hostility and coronary heart disease. Moreover, a measure of antagonistic hostility, relative to cynical and neurotic hostility, was the best predictor of lipid levels.