The development of a short form of the manifest anxiety scale

Religion and anxiety: A critical review of the literature

Religion's effects on mental health have been debated for years, yet only in the last half century have these theories been empirically tested. While a number of mental health constructs have been linked to religion, one of the most prevalent and debilitating mental health indices, anxiety, has been largely ignored. This paper categorizes and critically reviews the current literature on religion and general indices of anxiety in terms of findings linking decreased anxiety to religiosity, increased anxiety to religiosity, and those finding no relation between anxiety and religiosity. Results from 17 studies are described and synthesized. Conceptual and methodological weaknesses that potentially threaten the validity and generalizability of the findings are discussed. Finally, conclusions and directions for future research are provided.

TC-oriented supported housing for homeless MICAs

This article describes a TC-oriented aftercare program for homeless mentally ill chemical abusers (MICAs) in a supported housing facility, and presents some preliminary data on program effectiveness. The study divided the clients who had completed a residential modified TC program into two groups--those who participated in the TC-oriented supported housing program and those who did not. The data show similarities in the profile of the two groups. Improvement in negative behaviors (e.g., drug use and crime) occurred during the residential program and stabilized during the supported housing program, while improvement in prosocial behaviors (e.g., psychological functioning and employment) was incremental and continuous over the course of both programs. Those who participated in the TC-oriented supported housing program demonstrated significantly better outcomes than those who did not. These findings provide preliminary evidence for the effectiveness of a TC-oriented supported housing program as an aftercare strategy for homeless MICA clients following residential treatment.

Psychological risk factors for HIV pathogenesis: mediation by the autonomic nervous system

BACKGROUND

Epidemiologic studies have identified psychological risk factors for specific physical diseases, but the biological mechanisms mediating these relationships remain poorly defined.

METHODS

Social inhibition and autonomic nervous system (ANS) activity were assessed on multiple occasions in 54 gay men with asymptomatic human immunodeficiency virus (HIV) infection. Following baseline ANS assessment, plasma HIV-1 viral load and CD4+ T cell levels were monitored for 12-18 months to assess relationships between ANS activity and HIV pathogenesis.

RESULTS

We confirmed the previously reported relationship between socially inhibited temperament and vulnerability to viral pathology. Plasma viral load set-point was elevated eight-fold in socially inhibited individuals, and these individuals showed poorer virologic and immunologic response to initiation of highly active antiretroviral therapy (HAART). Effects were independent of duration of infection, HAART regimen, demographic characteristics, and health-relevant behavior. Neurophysiologic assessments documented elevated ANS activity in socially inhibited individuals, and mediational analyses showed that such differences could account for 64%-92% of the covariance between social inhibition and virologic parameters.

CONCLUSIONS

These data provide the first clinical evidence that differential neural activity mediates relationships between psychological risk factors and infectious disease pathogenesis. Such findings also suggest novel targets for adjunctive therapy in long-term control of HIV-1 disease.

Rationale, design, and baseline data for Commit to Quit II: an evaluation of the efficacy of moderate-intensity physical activity as an aid to smoking cessation in women

BACKGROUND

Commit to Quit II is a 4-year randomized controlled trial comparing the efficacy of a cognitive-behavioral smoking cessation treatment plus moderate-intensity physical activity with the same cessation treatment plus contact control.

METHODS

Sedentary women smokers (n = 217) were randomized to receive 8 weeks of treatment followed by 12 months of follow-up. This article outlines the study design, presents baseline data about the sample, and compares the sample to national samples and to our previous study examining vigorous-intensity exercise as an aid to smoking cessation.

RESULTS

Married and white participants reported significantly higher levels of nicotine dependence than unmarried and minority participants. Higher levels of nicotine dependence were also significantly related to lower smoking cessation self-efficacy and higher levels of self-reported depression, anxiety, and perceived stress. Additionally, participants smoked significantly more cigarettes (mean 20.6) than a national sample of female smokers (mean 16.1). On average, participants were significantly older, weighed significantly more, and scored significantly higher on a measure of anxiety than participants in our previous trial.

CONCLUSIONS

Our sample consisted of women who were heavier smokers than national samples seeking treatment. It remains to be determined how this will impact their ability to attain cessation in the present study.

Dementia caregiver intervention research: in search of clinical significance

PURPOSE

We reviewed intervention studies that reported dementia caregiver outcomes published since 1996, including psychosocial interventions for caregivers and environmental and pharmacological interventions for care recipients. Our goal was to focus on issues of clinical significance in caregiver intervention research in order to move the field toward a greater emphasis on achieving reliable and clinically meaningful outcomes.

DESIGN AND METHODS

MEDLINE, PsycINFO, and Cumulative Index to Nursing & Allied Health databases from 1996 through 2001 were searched to identify articles and book chapters mapping to two medical subject headings: caregivers and either dementia or Alzheimer's disease. Articles were evaluated on two dimensions, outcomes in four domains thought to be important to the individual or society and the magnitude of reported effects for these outcomes in order to determine if they were large enough to be clinically meaningful.

RESULTS

Although many studies have reported small to moderate statistically significant effects on a broad range of outcomes, only a small proportion of these studies achieved clinically meaningful outcomes. Nevertheless, caregiving intervention studies have increasingly shown promise of affecting important public health outcomes in areas such as service utilization, including delayed institutionalization; psychiatric symptomatology, including the successful treatment of major and minor depression; and providing services that are highly valued by caregivers.

IMPLICATIONS

Assessment of clinical significance in addition to statistical significance is needed in this research area. Specific recommendations on design, measurement, and conceptual issues are made to enhance the clinical significance of future research.

An index of self-regulation of emotion and the study of repression in social contexts that threaten or do not threaten self-concept

This research tests a model of repression (M. Mendolia, 1999; M. Mendolia, J. Moore, & A. Tesser, 1996) which specifies that the interaction of individual differences in emotional responsiveness and situational threats to self-concept contributes to one's tendency to regulate emotional responsiveness. This research demonstrates that (a) individuals regulate their autonomic activity, facial muscle activity, cognitive attention, and subjective experience during isolated and repeated exposures to self-threatening negative and positive emotional events and (b) repressive behavior can be predicted by the Index of Self-Regulation of Emotion, which complements and extends conventional categorical measures of dispositional repression. This model provides a more detailed understanding of basic mechanisms in emotion by identifying how individual differences in emotionality and particular social contexts contribute to self-regulation of emotion.

Nightmare frequency, nightmare distress, and anxiety

Using the self-reports of 300 university students, we replicated and extended the results of a 1971 study of Hersen by demonstrating a significant relationship between both nightmare frequency and nightmare distress with two dimensions of anxiety. Our results are not consistent with the 1990 findings of Wood and Bootzin who concluded that both nightmare frequency and nightmare distress were not correlated with anxiety.

An exercise program for women who are caring for relatives with dementia

OBJECTIVE

This study describes factors related to retention and adherence to an exercise program for women caregivers.

METHODS

One hundred sedentary women (average age = 62 years) caring for relatives with dementia were randomly assigned to an exercise program or an attention control (nutrition education) condition. Participants in the exercise condition received 12 months of home-based exercise counseling to achieve at least four exercise sessions per week, for at least 30 minutes per session. Adherence was tracked through monthly exercise logs, validated in a subsample by ambulatory heart rate and motion monitors. Participants also completed a psychosocial questionnaire battery at baseline and 12 months after randomization.

RESULTS

Participants achieved a 12-month average exercise adherence rate of 74% (ie, three exercise sessions per week) with an average of 35 minutes per session. At 12 months, the exercise condition demonstrated increased knowledge of the benefits of exercise and increased motivational readiness for exercise compared with the nutrition education condition. Both groups significantly improved in perceived stress, burden, and depression from baseline to posttest. Women who were older, less depressed, and more anxious at baseline showed better program retention, and lower baseline depression was associated with better exercise adherence.

CONCLUSIONS

This study demonstrates the feasibility and success of delivering home-based health promotion counseling for improving physical activity levels in a highly stressed and burdened population. Given the independent risk factors of caregiving and physical inactivity on mortality, programs to improve healthful behaviors are needed to preserve the health of caregivers as they undertake this important familial and societal role.

Defensiveness and individual response stereotypy in asthma

OBJECTIVE

Previous literature has shown that the psychological trait of defensiveness is related to elevated sympathetic reactivity to stress and to several cardiac risk factors. The aim of this study was to examine whether these previous findings on defensiveness extend to an asthmatic population.

METHODS

Defensiveness was measured by the Marlowe-Crowne Social Desirability Scale using a quartile split: high (upper 25%) and low (bottom 75%). Twenty-two defensive and 66 nondefensive participants with asthma were exposed to laboratory tasks (initial baseline rest period, reaction time task, and a shop accident film).

RESULTS

During the tasks there was evidence of lower skin conductance levels and greater respiratory sinus arrhythmia amplitudes among defensive patients with asthma. After exposure to the tasks, defensive patients with asthma showed a decline on spirometry test measures compared with nondefensive asthmatic patients, who displayed an increase.

CONCLUSIONS

These data confirm individual response stereotypy and suggest that defensiveness may be characterized by sympathetic hypoarousal and parasympathetic hyperarousal among patients with asthma. Future studies are needed to determine whether defensiveness is a risk factor for stress-induced bronchoconstriction.

Men gain additional psychological benefits by adding exercise to a weight-loss program

OBJECTIVE

Adding exercise to a comprehensive weight-loss program might not only attenuate any psychological distress associated with weight-loss attempts but also may provide psychological benefits. This study examined whether a diet-plus-exercise weight-loss program improved psychological outcomes more than a diet-only weight-loss program or an assessment-only control group.

RESEARCH METHODS AND PROCEDURES

This study was part of a larger 1-year randomized weight-loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year.

RESULTS

Men and women in either weight-loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet-plus-exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet-only program. Women in the diet-plus-exercise program did not experience additional psychological benefits specific to weight control than those in the diet-only program, despite increases in aerobic capacity.

DISCUSSION

The pattern seen for overweight men in the diet-plus-exercise program at 1 year-greater restraint, less disinhibition, and less hunger-is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women.

A repressive coping style and affective, facial and physiological responses to looking at emotional pictures

Previous studies have demonstrated increased physiological-emotional responses despite relatively low self-reported affect for individuals with a repressive coping style, as compared to control groups. The main question in the current study was whether such group differences could also be demonstrated by using the picture perception methodology of Lang. A second question was whether differences between these groups could be found in the habituation of physiological and emotional responses. Repressors (n=14), 'truly' low anxious participants (n=14), and moderately high anxious participants (n=13) were selected with the Marlowe-Crowne Social Desirability Scale and the Taylor Manifest Anxiety Scale. Two sets of 27 pictures with alternating neutral, threatening and sexual content were presented whilst valence and arousal ratings, skin conductance, heart rate and facial muscle responses were measured. No straightforward group differences were found. However, the results suggest that differential habituation, and not a repressive coping style, may contribute to differential self-reported, facial and physiological-emotional responses.

Defensive coping styles in chronic fatigue syndrome

OBJECTIVE

The cognitive-behavioral model of chronic fatigue syndrome (CFS) proposes that rigidly held beliefs act to defend individuals against low self-esteem. This study is the first to investigate the prevalence of a potential mechanism, the Defensive High Anxious coping style, among individuals with CFS.

METHODS

The study comprised 68 participants (24 CFS; 24 healthy volunteers; 20 chronic illness volunteers). Participants completed the Bendig short form of the Taylor Manifest Anxiety Scale (B-MAS) and the Marlowe-Crowne Social Desirability Scale (MC) in order to ascertain the distribution of participants in each group within the four coping styles defined by Weinberger et al. [J. Abnorm. Psychol. 88 (1979) 369].

RESULTS

A greater number of participants in the CFS group (46%) were classified as Defensive High Anxious compared to the two comparison groups [chi(2)(2)=8.84, P=.012].

CONCLUSION

This study provides support for the existence of defensive coping mechanisms as described by the cognitive-behavioral model of CFS. Furthermore, it has been suggested that this particular coping style may impinge directly on physical well being through similar mechanisms as identified in CFS, and further research linking these areas of research is warranted.

Anxiety and repression in attention and retention

High- and low-anxious college students (as determined by scores on the Taylor Manifest Anxiety Scale; A. W. Bendig, 1956) and repressors (low anxiety and high scores on the Marlowe-Crowne Social Desirability Scale; D. P. Crowne & D. Marlowe, 1964) were compared on 3 cognitive tasks. High-anxious participants more often spelled the negative emotional meaning of ambiguous homophones (e.g., pane/pain) and forgot more of their free associations to emotional cue words than did the low-anxious participants. The repressors also detected the emotional meaning of the homophones but unlike the anxious, the repressors did recall their associations to the emotional words. In a working memory task using nonemotional items, the moderately anxious participants recalled fewer words than did the low- and high-anxious participants. The results confirm that both trait anxiety and repression affect information processing at a variety of stages but not in the same way. Repressors were sensitive to, and retentive of, negative emotional stimuli.

Age at earliest reported memory: associations with personality traits, behavioral health, and repression

The present study examined relationships between the age at earliest memory and the personality traits and behavioral health of 107 undergraduates. Participants answered questions on their earliest memory and completed the Myers-Briggs Type Indicator (MBTI) and a medical history form. Analyses indicated that continuous scores on two MBTI scales (Sensing-Intuition and Judging-Perceiving) were inversely related to age at earliest memory as were participant's self-reported drug and alcohol problems, emotional and psychological symptoms, accident rates, physical symptoms, and satisfaction with health. Respondents who reported first memories at or after 7 years of age (i.e., approximately 1 SD above the mean age at recalled memory) were classified as repressors. Repressors scored in the Sensing and Judging directions on the MBTI and reported significantly fewer emotional symptoms, accidents, psychological symptoms, and less health satisfaction than nonrepressors. Results are consistent with the age at earliest memory and repression literature and support the use of earliest memory age as an index of repression.

Anxiety and attention to threatening pictures

Previous research using attentional search tasks has revealed an anxiety-related bias favouring attention to threatening words when they are presented simultaneously with emotionally neutral words. In Experiment 1, using a similar task, a related effect was found here with emotionally threatening pictures. When pictures were used as location cues in a second experiment, high-trait anxious individuals were slower than less anxious controls when responding to targets requiring attentional disengagement from threat, and they were slower in general with pictures judged to be highly threatening. In a third experiment using the same task but with a longer cue exposure, a related disengagement difficulty occurred across both groups, although the more general slowing with severe threat was again confined to the anxious group. We conclude that attentional bias involves both a specific difficulty in disengaging attention from the location of any threat and a more general interference effect that is related to threat level.

Heart rate, neuroendocrine, and immunological reactivity in response to an acute laboratory stressor

OBJECTIVE

The primary objective of the present study was to identify neuroendocrine and immunological correlates of cardiovascular reactivity to an acute laboratory stressor.

METHODS

Subjects were 56 healthy volunteers. Heart rate and blood pressure were assessed at regular intervals during a 30-minute adaptation period and a 6-minute videotaped speech task. Blood was drawn before and after the task and was assayed for natural killer cell activity (NKCA), cortisol production, in vitro interferon gamma (IFN-gamma) and interleukin 10 production by peripheral blood mononuclear cells (PBMC), and antibody titers to the Epstein-Barr virus. Psychological measures were also administered.

RESULTS

NKCA increased significantly in response to the task, and this increase was significantly and positively correlated with heart rate reactivity. IFN-gamma production by PBMC also increased in response to the task, but these increases were unrelated to heart rate reactivity. In addition, baseline cortisol levels were found to be predictive of heart rate reactivity. Finally, questionnaire data were modestly related to various aspects of stress-induced reactivity.

CONCLUSIONS

Consistent with the task-related increases in NKCA and IFN-gamma, acute stress may signal an increase in at least some aspects of the cell-mediated, or TH1-driven, immune response. Furthermore, the finding that heart rate reactivity was related in part to baseline individual differences in cortisol production suggests that short-term cardiovascular responses to stress may be directly related to longer-term neuroendocrine modulation. Finally, the present results also help to highlight the influence of both sympathetic and nonsympathetic pathways in the response to acute stressors and suggest tentative links between certain psychological traits and various aspects of stress-induced reactivity.

Psychophysiological correlates of individual differences in patterns of hemodynamic reactivity

The present study delineates a method for the quantification of six hemodynamic reactivity patterns, in response to a laboratory stressor, and examines the psychophysiological correlates of individual differences in these patterns. One hundred and ninety-four young adult men and women participated in rest periods and two laboratory stressors, mental arithmetic and an anger recall interview. Measures were taken of blood pressure, heart rate, and cardiac output, from which total peripheral resistance was derived, as well as state reports of feelings during the tasks. Six hemodynamic reactor patterns were identified: Non-reactors, Mild Myocardials, Mild Vasculars, Myocardials, Vasculars, and Dual Reactors, each associated with a unique profile of cardiac output and total peripheral resistance change. Myocardial reactors to the interview had the highest resting levels of blood pressure and total peripheral resistance. Dual reactors had the largest increases in diastolic reactivity; Dual and Myocardial reactors had the largest increases in systolic reactivity. The extreme reactor groups (Dual, Myocardial, Vascular) all reported greater task invigoration than the Non-reactors, who reported greater efforts to relax. Reactor groups were similar on anger-related trait affect. Based on both resting blood pressure and magnitude of task-induced reactivity, Myocardial and Dual reactors may be at the greatest risk for subsequent hypertension.

Religious faith and spirituality in substance abuse recovery: determining the mental health benefits

Recently, mental health professionals have begun examining the potential value of religious faith and spirituality in the lives of individuals suffering from a variety of acute and chronic illnesses. This study explored the relation between religious faith, spirituality, and mental health outcomes in 236 individuals recovering from substance abuse. We found that recovering individuals tend to report high levels of religious faith and religious affiliation, but choose to rate themselves as being more spiritual than religious. Results also indicate that among recovering individuals, higher levels of religious faith and spirituality were associated with a more optimistic life orientation, greater perceived social support, higher resilience to stress, and lower levels of anxiety. This represents the largest self-report study to date examining the relation between religious faith, spirituality, and mental health outcomes among individuals recovering from substance abuse.

Modified therapeutic community for homeless mentally ill chemical abusers: treatment outcomes

This study compared homeless mentally ill chemical abuser (MICA) clients (n = 342), male and female, sequentially assigned to either of two modified therapeutic community programs (TC1 and TC2) and to a treatment-as-usual (TAU) control group. Follow-up interviews were obtained at 12 months postbaseline and at time F (on average more than 2 years postbaseline) on a retrieved sample of 232 (68%) clients and 281 (82%) clients, respectively. Outcome measures assessed five domains: drug use, crime, HIV risk behavior, psychological symptoms, and employment. Individuals in both modified TC groups showed significantly greater behavioral improvement than TAU at 12 months and time F, and the modified TC2, with lower demands and more staff guidance, was superior to modified TC1. Completers of both TC programs showed significantly greater improvement than dropouts and a subgroup of TAU clients with high exposure (i.e., more than 8 months) to other treatment protocols. The present findings support the effectiveness and longer term stability of effects of a modified TC program for treating homeless MICA clients.

Negative affectivity, restriction of emotions, and site of metastases predict mortality in recurrent breast cancer

OBJECTIVE

To assess whether negative affectivity and restriction of emotions predict survival time with recurrent breast cancer.

METHODS

Thirty-two patients with recurrent breast cancer, diagnosed 6-19 months earlier and stabilized using surgical, medical and/or radiation therapies, were enrolled. Cox regression survival analyses, including initial severity of metastases (RR=4.3 [1.3-14.3]; p=0.02), were used to explore the association of psychological variables with survival.

RESULTS

Low chronic anxiety in the context of low emotional constraint predicted low mortality (RR 0.07 [0.01-0.52]; p=0.007). However, patients with low chronic anxiety scores but with high constraint had higher mortality (RR=3.7 [1.2-11.5; p=0.02). High chronic anxiety, with or without high constraint, also predicted earlier death, as did high control of feelings.

CONCLUSION

An integrated model of negative affectivity in the context of restriction of emotions appears to strengthen the prediction of survival based on severity of breast cancer metastases.

Pervasive emotion recognition deficit common to alexithymia and the repressive coping style

OBJECTIVE

Previous research has demonstrated a deficit in the ability to recognize emotions in alexithymic individuals. The repressive coping style is thought to preferentially impair the detection of unpleasant compared with pleasant emotions, and the degree of deficit is typically thought to be less severe than in alexithymia. We compared emotion recognition ability in both individuals with alexithymia and those with the repressive coping style.

METHODS

Three hundred seventy-nine subjects completed the 20-item Toronto Alexithymia Scale, the Levels of Emotional Awareness Scale, the Marlowe-Crowne Scale (a measure of repressive defensiveness), the Bendig Short Form of the Taylor Manifest Anxiety Scale, and the Perception of Affect Task. The Perception of Affect Task consists of four 35-item emotion recognition subtasks: matching sentences and words, faces and words, sentences and faces, and faces and photographs of scenes. The stimuli in each subtask consist of seven emotions (happiness, sadness, anger, fear, disgust, surprise, and neutral) depicted five times each. Recognition accuracy results were collapsed across subtasks within each emotion category.

RESULTS

Highly alexithymic subjects (for all, p<.01) and those with low emotional awareness (for all, p<.001) were consistently less accurate in emotion recognition in all seven categories. Highly defensive subjects (including repressors) were less accurate in the detection of anger, sadness, fear, and happiness (for all, p<.05). Furthermore, scores on the Levels of Emotional Awareness Scale accounted for significantly more variance in performance on the Perception of Affect Task than scores on the Marlowe-Crowne Scale (p<.01).

CONCLUSIONS

The results indicate that alexithymia and the repressive coping style are each associated with impairments in the recognition of both pleasant and unpleasant emotions and that the two styles of emotional self-regulation differ more in the magnitude than in the quality of these impairments.

Antagonistic behavior, dominance, hostility, and coronary heart disease

PURPOSE

This study investigated the relationship between antagonistic behavior, dominance, attitudinal hostility, and coronary heart disease (CHD).

METHODS

One hundred one men and 95 women referred for thallium stress testing were administered the Structured Interview and the Cook-Medley Hostility Scale. The Hostile Behavior Index, derived from the Structured Interview and developed by Haney et al., served as an index of antagonism, and the frequency with which interviewees interrupted their interviewer served as a measure of dominance. On the basis of their medical history and thallium stress test results, patients were classified as having (N = 44) or not having (N = 99) CHD.

RESULTS AND CONCLUSIONS

Multivariate logistic regressions (with age, gender, disease, and lifestyle risk factors in the model) revealed that both the Hostile Behavior Index and dominance were significant independent risk factors for CHD (relative risk [RR] = 1.22 and 1.47, p < .03). Of the two Hostile Behavior Index component scores, indirect challenge and irritability, only the latter correlated significantly with CHD (RR = 1.27, p < .03). Separate logistic regressions for men and women suggest that subtle, indirect manifestations of antagonism confer CHD risk in women and that more overt expressions of anger confer risk in men. A significant univariate correlation between hostility scale scores and CHD became not significant when we adjusted for socioeconomic status.

History of depression and subsyndromal depression in women smokers

While Major Depressive Disorder (MDD) is associated with difficulty quitting smoking, few studies have examined the role of subsyndromal depression (SubD). We examined pretreatment differences in smoking, weight concerns, and negative affect among three groups of women (N = 281) enrolling in a smoking cessation program who responded to a self-report questionnaire about the lifetime presence of MDD symptoms: self-report positive for MDD, self-report positive for SubD, and self-report negative for depression (fulfilling either DSM-III-R symptom or duration criteria, but not both). Compared to MDD Subjects (Ss), SubD Ss were more likely to report eating disordered behaviors. Compared to Non-Depressed (Non-Dep) Ss, SubD Ss initiated smoking earlier, and reported greater previous withdrawal symptoms, more eating disordered behaviors, and higher anxiety, depression, and stress. Compared to Non-Dep Ss, MDD Ss reported a greater smoking rate during their heaviest usage period, greater previous withdrawal symptoms, lower self-efficacy to manage food intake (especially during negative affect situations), and greater depression and anxiety. Many of these significant differences disappeared when SubD Ss were combined with Non-Dep Ss and compared with MDD Ss as is done traditionally. SubD does not appear to be on a continuum with Non-Dep and MDD groups, but rather warrants further investigation as a discrete subset of smokers. The implications for assessment and treatment are discussed.

Modified therapeutic community for homeless mentally ill chemical abusers: emerging subtypes

This paper is one of a series reporting on a clinical field trial evaluating the efficacy of the modified therapeutic community (TC) approach for the treatment of homeless mentally ill chemical abusers (MICAs). The social and psychological characteristics of the treatment sample were described in an earlier paper; the purpose of the present report was to categorize subtypes of homeless MICA clients to predict with greater accuracy their treatability in modified TCs. An index that consistently correlated with treatment-relevant variables was identified for each of three dimensions; Homelessness (residential instability), Mental Illness (current severity), and Substance Abuse (current substance abuse/dependence diagnosis). These indices yielded distributions that captured the variability in the sample with respect to a number of variables, including drug use, criminality, human immunodeficiency virus (HIV) risk (sexual behavior), psychological status, and motivation. Bivariate and multivariate analyses showed that the indices were not strongly related to demographic variables such as race/ethnicity, age, or gender, but were significantly associated with baseline drug use, criminal activity, HIV risk (sexual behavior), psychological symptoms, and motivation and readiness. These findings indicate that, even among those admitted to residential treatment for substance abuse, homeless MICA clients are not homogeneous; rather, subgroup differences emerge among the indices of homelessness, mental illness, and substance abuse. The efficacy of treatment in modified TCs for these subgroups will be assessed in subsequent papers examining the relationships among the three indices, client retention, and outcomes during and subsequent to residential treatment.

Differential immune system changes with acute and persistent stress for optimists vs pessimists

This study investigated whether acute and persistent stressors and life change events were followed by changes in immune status, and whether dispositional optimism moderated these relationships. Thirty-nine healthy women ages 18-45 were followed prospectively for 3 months, with weekly assessment of acute and persistent stressors and monthly assessment of life events and immune parameters (NK cell cytotoxicity, and CD4 and CD8 T cell subsets). The study used an autoregressive linear model to examine how weekly appraised acute and persistent stress levels were associated with immune parameters in the subsequent week. Analyses revealed that the immune outcomes were differentially affected by acute and persistent stressors. Further, the association between acute stress and subsequent immune parameters was buffered by an optimistic perspective. However, when stress persisted at high levels, optimists showed more subsequent immune decrements than pessimists.

Modified therapeutic community for mentally ill chemical abusers: outcomes and costs

Several studies have established that the personal and social consequences of substance abuse are extensive and costly. These consequences are frequently compounded by mental illness. Although interventions that target mentally ill chemical abusers (MICAs) present several challenges, the potential benefits of successful interventions are significant. This article presents outcomes and costs of a modified therapeutic community (TC) intervention for homeless MICAs. Outcomes at follow-up are compared with those for a control group of homeless MICAs receiving standard services in a "treatment-as-usual" (TAU) condition. Annual economic costs for the modified TC and the average weekly cost of treating a single client are estimated. Treatment and other health service costs at 12 months postbaseline are compared for modified TC and TAU clients. The results of this study indicate that, suitably modified, the TC approach is an effective treatment alternative for homeless MICAs, with the potential to be highly cost-effective relative to standard services.

Repressive/defensive coping, endogenous opioids and health: how a life so perfect can make you sick

Hyperactivity of endogenous opioid systems has been postulated to mediate the associations between defensive/repressive coping styles, enhanced stress responsivity, and reduced immunocompetence. Study 1 examined whether repressive/defensive coping would be associated with greater sensitivity to opioid antagonism. Judgments of the painfulness of ascending series of electrocutaneous stimulation applied to the forearm were determined before and after the administration of naloxone and placebo in 38 men and 42 women. All subjects were healthy with a mean age of 32.9 years. Naloxone (10 mg i.v.) and placebo were administered in double-blind fashion and counterbalanced. Subjects were classified as High- and Low-defensive and repressive copers on the basis of scores on the Marlowe-Crowne Social Desirability Scale and the Balanced Inventory of Desirable Responding, respectively. High Self-Deception was associated with naloxone-induced hyperalgesia, whereas no effects of naloxone on pain ratings were observed in low-Self-Deceptive subjects. In Study 2, resting plasma beta-endorphin levels were found to be positively correlated with defensiveness in men (n = 26), but not women (n = 44). Study 3 examined 82 healthy subjects (mean age = 28.7 years). Beta-endorphin/defensiveness correlations were found to be greater following, compared to prior to, electrical nociceptive stimulation in men (n = 49), but unrelated in women (n = 33). These findings are consistent with the hypothesized endorphinergic dysregulation associated with repressive/defensive coping styles and are discussed in terms of the immuno-regulatory implications of such a dysregulation.

Weight control smoking among sedentary women

This study examined characteristics associated with weight control smoking among 281 sedentary women enrolled in a smoking cessation trial. A series of regression models were developed to identify predictors of weight control smoking as measured by the Smoking Situations Questionnaire. Predictor variables included demographic variables, dietary intake, weight gain following previous quit attempts, dietary restraint, self-efficacy for weight management, smoking behavior, exercise behavior, negative affect and psychological constructs relevant to smoking cessation, and exercise adoption. In the final predictor model, anticipation of weight gain in the current quit attempt, higher dietary restraint, younger age, greater Fagerstrom scores, greater number of pounds gained in previous quit attempts, and lower levels of self-efficacy to manage weight in negative affect situations were associated with smoking for weight control. Treatment implications for women who smoke for weight control reasons are discussed.

Dimensions of anger and CHD in men and women: self-ratings versus spouse ratings

One hundred one males and 95 females referred for thallium stress testing were administered Spielberger's State-Trait Anger Expression Inventory (STAXI), the Ho scale cynicism items, the Cynical Beliefs Scale, and Bendig's Manifest Anxiety Scale. A subset of 53 males and 43 females was rated by their spouses by means of STAXI. Based on the thallium findings and their medical history, patients were classified either as healthy, or as having documented CHD, or as questionable. Patients' STAXI and cynicism measures were submitted to a principal-components analysis which yielded three factors: Impulsive Anger-out. Inwardly experienced anger, and Cynicism. The relationships between factor scores and documented CHD was determined by means of logistic regression analyses. Only Impulsive Anger-out correlated (positively) with CHD, but only when based on spouses' ratings and only in males (p < .01, RR = 3.13). Covarying traditional risk factors and cynicism did not attenuate this relationship. However, a significant relationship between Ho scale cynicism and CHD did not survive adjustment for traditional risk factors. Anxiety was not a risk factor for CHD.

Enhancing physical and psychological functioning in older family caregivers: the role of regular physical activity

Although informal caregiving among older adults creates a range of physical and psychological burdens for the caregiver, little research has been directed at evaluating strategies for preserving caregivers physical functioning in addition to their psychological well-being. The purpose of the current research was to examine, through population-based survey sampling procedures, levels of physical activity and related health practices and preferences among a random sample of older family caregivers; evaluate, using an experimental design, the feasibility of initiating a four-month supervised home-based moderate-intensity physical activity regimen among older family caregivers; and explore the potential effects of physical activity on anger expression, caregiver burden, and related psychological outcomes in this population. The results suggest that: (a) physical inactivity is a prevalent risk factor among family caregivers that requires systematic attention; (b) a significant proportion of family caregivers of both sexes are interested in improving their physical activity levels, especially through programs that do not require ongoing attendance at a class or group; and (c) supervised home-based programs that focus on brisk walking and similar moderate-intensity physical activities appear to be both feasible and potentially beneficial in health (e.g. ambulatory blood pressure) as well as mental health (e.g. anger expression) areas.

Social relationships and immune processes in HIV seropositive gay and bisexual men

This three-year longitudinal study assessed the association between social relationships and human immunodeficiency virus (HIV) progression in individuals at risk for morbidity and mortality due to acquired immune deficiency syndrome (AIDS). Two-hundred five HIV seropositive men without AIDS completed measures of social integration and loneliness at baseline. Blood samples used to assess CD4 T-lymphocyte levels were collected at baseline and at six-month intervals for a three-year follow-up period. Contrary to expectation, lower levels of baseline loneliness predicted more rapid declines in CD4 levels over the follow-up period. This association was independent of baseline CD4 values, negative affect, and health practices. A series of mediational analyses revealed that sexual behavior, medication use, bereavement, coping, and a number of other variables were not mechanisms through which loneliness affected the immune system. Loneliness was not associated with time to AIDS diagnosis or time to AIDS-related mortality. These findings are consistent with the emerging view that social relationships can have deleterious, as well as protective, influences on health outcomes.