Cognitive adaptation, psychological adjustment, and disease progression among angioplasty patients: 4 years later

Scientific opportunities in resilience research for cardiovascular health and wellness. Report from a National Heart, Lung, and Blood Institute workshop

Exposure of biological systems to acute or chronic insults triggers a host of molecular and physiological responses to either tolerate, adapt, or fully restore homeostasis; these responses constitute the hallmarks of resilience. Given the many facets, dimensions, and discipline-specific focus, gaining a shared understanding of "resilience" has been identified as a priority for supporting advances in cardiovascular health. This report is based on the working definition: "Resilience is the ability of living systems to successfully maintain or return to homeostasis in response to physical, molecular, individual, social, societal, or environmental stressors or challenges," developed after considering many factors contributing to cardiovascular resilience through deliberations of multidisciplinary experts convened by the National Heart, Lung, and Blood Institute during a workshop entitled: "Enhancing Resilience for Cardiovascular Health and Wellness." Some of the main emerging themes that support the possibility of enhancing resilience for cardiovascular health include optimal energy management and substrate diversity, a robust immune system that safeguards tissue homeostasis, and social and community support. The report also highlights existing research challenges, along with immediate and long-term opportunities for resilience research. Certain immediate opportunities identified are based on leveraging existing high-dimensional data from longitudinal clinical studies to identify vascular resilience measures, create a 'resilience index,' and adopt a life-course approach. Long-term opportunities include developing quantitative cell/organ/system/community models to identify resilience factors and mechanisms at these various levels, designing experimental and clinical interventions that specifically assess resilience, adopting global sharing of resilience-related data, and cross-domain training of next-generation researchers in this field.

Early development of a novel scale to measure adaptation in people diagnosed with inflammatory bowel disease - the A-inflammatory bowel disease

Objective

To undergo the preliminary development of a new measure of patient adaptation to Inflammatory Bowel Disease (IBD): A-IBD.

Design

Based on a prior conceptualisation of adaptation, a 40-item scale was generated and completed by 304 people diagnosed with IBD.

Main outcome measures

Psychometric analysis of the measure. Association with the Brief Illness Perception Questionnaire (Brief IPQ) and the Inflammatory Bowel Disease Questionnaire (IBDQ).

Results

The 18-item scale consisted of four subscales (patient identity, person identity, acceptance, expectations). Weak to moderate correlations were found between subscales of the A-IBD and the Brief IPQ and IBDQ.

Conclusion

The A-IBD shows potential for assessing adaptation. Further analysis could confirm its usefulness.

Correlates of Post-traumatic Growth Following a Myocardial Infarction: A Systematic Review

Correlates of post-traumatic growth (PTG) have been examined in the area of health psychology previously, with much focus on aspects of personality, coping, and social support. This systematic review aimed to examine correlates of PTG for those who have experienced a myocardial infarction (MI). Studies which met inclusion criteria were assessed for quality and reviewed. Results showed an inconsistent strength of associations between studies and so conclusions cannot be drawn. Possible reasons for these differences are discussed and recommendations for future research are suggested.

Is it better to cultivate positive affect or optimism? Predicting improvements in medical adherence following a positive psychology intervention in patients with acute coronary syndrome

OBJECTIVE

Adherence to health behaviors following an acute coronary syndrome (ACS) is strongly associated with superior prognosis. Both optimism and positive affect may play important roles in such adherence. However, the relationship between changes in these constructs in the context of positive psychology interventions (PPIs) and adherence to health behaviors is not fully understood. Accordingly, we aimed to examine these relationships among a cohort of post-ACS patients receiving a PPI.

METHOD

Post-ACS participants who received a PPI during a factorial trial (N = 128) completed self-report measures of positive affect and optimism, along with the Medical Outcomes Study Specific Adherence Scale items for diet, physical activity, and medication adherence, over 16 weeks. The baseline and longitudinal effects of positive affect and optimism-representing changes in those constructs-on adherence were analyzed using mixed effects regression models.

RESULTS

Positive affect, but not optimism, was longitudinally associated with greater overall adherence to health behaviors (positive affect: β = 0.057, p = .006; optimism: β = 0.032, p = .36), with the effect driven by physical activity adherence (positive affect: β = 0.040, p = .004; optimism: β = 0.005, p = .83).

CONCLUSION

Changes in positive affect may be more strongly associated with post-ACS adherence than optimism; this could have important implications for the development of PPIs to promote adherence.

Commonalities and Differences in Psychological Adjustment to Chronic Illnesses Among Older Adults: a Comparative Study Based on the Stress and Coping Paradigm

BACKGROUND

This study aimed to validate the role of the stress and coping paradigm in the context of psychological adjustment to chronic illnesses among older adults by using the structural equation modeling technique, as well as investigating the differences in structural weights between older adults with arthritis and older adults with hypertension.

METHOD

A cross-sectional study was conducted with 325 older adults with chronic illnesses (149 hypertension, 176 arthritis), aged 60-88 years, who completed questions on perceived social support, psychological resources, threat appraisal, self-efficacy, coping strategy, depressive symptoms, and anxiety.

RESULTS

The results revealed that older adults with arthritis experienced significantly higher anxiety (t = 2.91, p < 0.01) than those with hypertension, whereas no significant difference in their depressive symptoms was observed (t = 1.61, p > 0.05). Social support, psychological resources, threat appraisal, and self-efficacy had a significant direct relationship with psychological distress (β = - 0.15, β = - 0.38, β = 0.19, β = - 0.23, respectively). Multi-group analyses showed significant differences in structural weights between older adults with hypertension and those with arthritis (Δχ² = 41.336, Δdf = 18, p < 0.01).

CONCLUSION

The stress and coping paradigm appears to be applicable for adjustment to chronic illnesses by allowing direct paths from social support, psychological resources, threat appraisal, and self-efficacy to psychological distress. The differences in structural weights may offer an intervening angle for clinical practitioners to design targeted interventions for older adults with different types of chronic illnesses.

Personal Projects and Psychological Well-Being: Emerging Adults With and Without Diabetes

Objective

The goal of this study was to examine the nature of the personal projects that emerging adults with and without diabetes were pursuing and the implications of those projects for psychological well-being.

Methods

We asked emerging adults with and without type 1 diabetes to identify five personal projects, rate four dimensions of those projects (importance, typicality, stress, and progress), and complete several well-being measures (depressive symptoms, life purpose, life satisfaction, perceived stress, and resilience) when they were age 19. Those with diabetes also indicated the extent to which diabetes interfered with each of the projects. We followed participants for 1 year to determine the status of projects and reassess project dimensions and psychological well-being.

Results

The kinds of projects identified by the two groups were similar. However, those with diabetes reported lower levels of progress on projects and completed fewer projects 1 year later compared with controls. Project progress, importance, and completion were linked to higher psychological well-being, whereas project stress was linked to lower psychological well-being. However, the most robust cross-sectional and longitudinal predictor of psychological well-being was project typicality (i.e., the extent to which projects were typical of participants). The pursuit of more typical projects was linked to higher psychological well-being. These findings were largely similar for emerging adults with and without diabetes. Diabetes interference with projects revealed some links to psychological well-being.

Conclusions

These results suggest that personal project engagement and completion is linked to the overall mental health of emerging adults with and without diabetes.

Adjusting to Chronic Health Conditions

Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.

A Prospective Study of the Effects of Psychological Resources and Depression in Essential Hypertension

This study examined the influence of perceived health competence (PHC) and coping strategies in hypertension. Depressive mood state and dimensions of quality of life (QOL) (social support, satisfaction, well-being and free time) were also considered. One hundred and fifty participants were surveyed cross-sectionally and prospectively. Regression analysis revealed that the main predictors of the dimensions of QOL were PHC and depressive mood state. Emotional coping negatively predicted well-being. Unexpectedly, task-focused coping was unrelated to QOL domains. Longitudinal analyses did not support these relations. The data suggest that, in hypertension, PHC constitutes an important resource, whereas depressive mood state deteriorates QOL.

Mediation and moderation of the effects of watching the angiography screen on patients

It has been reported that allowing patients to watch the coronary angiography screen during the procedure results in psychological benefits. This study aimed to investigate the roles of illness perceptions as mediators of this outcome and to examine whether individual differences in monitoring coping style moderated these effects. The experiment compared patients who were instructed to watch the monitor screen (n = 57) with those who were not (n = 51). Questionnaires were used to measure the research variables at one day and one month after the procedure. Results showed that watching the angiography screen increased patients' personal and treatment control perceptions that mediated changes in self-assessed health, risk perceptions, negative affect, general and diet outcome expectancies, and diet and physical activity intentions. The behavior-related outcomes were moderated by monitoring coping style. These findings illustrate the significance of illness perceptions, perceived control and monitoring coping style in achieving desirable outcomes among patients undergoing coronary angiography, and reveal opportunities for interventions using medical imaging technologies.

Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: A systematic review

Depression and anxiety are well-known to be associated with adverse health outcomes in cardiac patients. However, there has been less work synthesizing the effects of positive psychological constructs (e.g., optimism) on health-related outcomes in cardiac patients. We completed a systematic review of prospective observational studies using established guidelines. A search of PubMed and PsycINFO databases from inception to January 2014 was used to identify articles. To be eligible, studies were required to assess effects of a positive psychological construct on subsequent health-related outcomes (including mortality, rehospitalizations, self-reported health status) in patients with established heart disease. Exploratory random effects' meta-analyses were performed on the subset of studies examining mortality or rehospitalizations. Seventy-seven analyses from 30 eligible studies (N=14,624) were identified. Among studies with 100 or more participants, 65.0% of all analyses and 64.7% of analyses adjusting for one or more covariates reported a significant (p<.05) association between positive psychological constructs and subsequent health outcomes. An exploratory meta-analysis of 11 studies showed that positive constructs were associated with reduced rates of rehospitalization or mortality in unadjusted (odds ratio=.87; 95% confidence interval [.83, .92]; p<.001) and adjusted analyses (odds ratio=.89; 95% confidence interval [.84, .91]; p<.001); there was little suggestion of publication bias. Among cardiac patients, positive psychological constructs appear to be prospectively associated with health outcomes in most but not all studies. Additional work is needed to identify which constructs are most important to cardiac health, and whether interventions can cultivate positive attributes and improve clinical outcomes.

Cognitive adaptation theory as a predictor of adjustment to emerging adulthood for youth with and without type 1 diabetes

OBJECTIVE

The purpose of the study was to determine whether resilience, defined by cognitive adaptation theory, predicted emerging adulthood outcomes among youth with and without type 1 diabetes.

METHODS

Youth with (n=118) and without type 1 diabetes (n=122), who were part of a previous longitudinal study during adolescence, completed on-line questionnaires during their senior year of high school and one and two years later. They were average age 18, 53% female, and 93% white. Questionnaires assessed cognitive adaptation theory (CAT) indicators (self-esteem, mastery, optimism) and psychological, relationship, behavioral, vocational, and, for those with diabetes, diabetes outcomes.

RESULTS

The CAT index at baseline predicted reduced psychological distress, enhanced psychological well-being, increased friend support, reduced friend conflict, the presence of romantic relationships, reduced likelihood of romantic breakups, higher GPA, higher work satisfaction, and lower work stress during the transition to emerging adulthood. Among those with diabetes, the CAT index predicted better self-care behavior and revealed a marginal relation to better glycemic control. Analyses controlled for baseline levels when appropriate. Findings were stronger one year than two years post high school graduation, and findings were stronger for those with than without diabetes. Youth with diabetes also scored lower on the CAT index than youth without diabetes.

CONCLUSIONS

These findings suggest that the implications of CAT include not only psychological health but also relationship, vocational, and diabetes outcomes. Those who score lower on CAT indicators should be identified as children so that interventions designed to enhance resilience can be implemented.

Posttraumatic recovery to distress symptoms ratio: a mediator of the links between gender, exposure to fire, economic condition, and three indices of resilience to fire disaster

This study investigated the direct and indirect effects of demographic predictors on level of resilience following a potentially traumatic event. We hypothesized that the direct effects of three variables (exposure to fire hazards, gender, and economic condition) on resilience following a fire disaster would be mediated by the proportion of posttraumatic recovery to post-fire distress symptoms. The sample consisted of 234 Israeli Druze youth whose hometown was endangered and damaged by the Mount Carmel fire disaster in December 2010. Results partially supported the research hypotheses.

Assessing depression in cardiac patients: what measures should be considered?

It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients' wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS), the Cognitive Behavioural Assessment Hospital Form (CBA-H), the Beck Depression Inventory (BDI), the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9), the Depression Interview and Structured Hamilton (DISH), the Hamilton Rating Scale for Depression (HAM-D/HRSD), and the Composite International Diagnostic Interview (CIDI). Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients.

Illness perceptions, mood and quality of life: a systematic review of coronary heart disease patients

OBJECTIVE

To examine published literature investigating the relationship between illness perceptions, mood and quality of life (QoL) in coronary heart disease (CHD) populations.

METHODS

Key databases were systematically searched (CINAHL, Medline, PsycINFO, Scopus and Web of Science) for studies matching the inclusion criteria between November 2011 and February 2012. References of included studies were examined and key authors contacted. Studies were subject to a quality control check.

RESULTS

21 studies met the inclusion criteria. A synthesis of the results found that illness perceptions were correlated to and predicted QoL and mood across CHD diagnoses. Specific illness perceptions (control, coherence and timeline) were found to be important for patients that had experienced an unexpected medical event, such as myocardial infarction.

CONCLUSION

The results of this study provide support that illness perceptions are related to outcomes across CHD populations and disease progression, however the results do not selectively support one particular model. Recommendations are consistent with cardiac rehabilitation guidelines. Further research should focus on the systemic impact of illness perceptions.

Cognitive adaptation to nonmelanoma skin cancer

Taylor's (1983) cognitive adaptation theory posits that when people go through life transitions, such as being diagnosed with a chronic disease, they adjust to their new reality. The adjustment process revolves around three themes: search for positive meaning in the experience or optimism, attempt to regain a sense of mastery in life, as well as an effort to enhance self-esteem. In the sample of 57 patients with nonmelanoma skin cancer the Cognitive Adaptation Index successfully predicted participants' distress (p < .001) accounting for 60% of the variance and lending support for the Taylor's theory of cognitive adaptation in this population.

Cognitive adaptation theory and quality of life in late-stage cancer patients

In this study, the question of whether using slightly illusionary, positive attributions of self, control, and meaning (e.g., cognitive adaptation theory), in the face of disconfirmatory evidence, facilitates quality of life in late-stage cancer patients was examined. Eighty late-stage cancer patients (Mean age = 59.7, SD = 12.5; 48.8% male, 51.2% female; varying cancer diagnoses) who recently failed or refused first line anti-neoplastic treatment completed questionnaires assessing meaning, control, self-esteem, and optimism, as well as physical and psychological quality of life. Findings suggest that greater self-esteem, control, and meaning predicted physical and psychological quality of life, with physical quality of life being influenced by control beliefs and psychological quality of life influenced by self-esteem. Optimism independently predicted physical quality of life and neither mediated nor moderated the relationship between cognitive adaptation and quality of life. Findings suggest that slightly positive, illusionary beliefs of self, control, and meaning predicted quality of life even in the presence of clear, disconfirmatory environmental evidence.

Toward a more complete understanding of the effects of personal mastery on cardiometabolic health

OBJECTIVE

A great deal of research has been devoted to identifying the psychological factors that might be associated with reduced risk for cardiovascular diseases. In particular, coping resources such as personal mastery might attenuate stress-related pathophysiology. The purpose of the present review was to examine the existing literature reporting associations between personal mastery and cardiometabolic health outcomes to determine which outcomes have been studied to date, investigate the extent of inconsistency in the literature, and propose new directions for research.

DESIGN

Systematic review of articles examining the associations between personal mastery and cardiometabolic health.

MAIN OUTCOME MEASURES

Studies were included if they examined objective measures of cardiometabolic function, cardiovascular events, and/or mortality.

RESULTS

Thirty-two studies were identified examining the effect of mastery on the following outcomes: mortality and/or cardiovascular events, psychoneuroendocrine stress systems, cardiovascular reactivity to acute stress, metabolic dysregulation, inflammation/coagulation, and evidence of large vessel disease from imaging methods.

CONCLUSIONS

Overall, mastery was associated with better cardiometabolic health and reduced risk for disease and/or death, typically with a small-medium effect size. A relatively small proportion of studies reported contradictory findings that higher mastery was associated with poorer cardiometabolic outcomes. The state of the current research suggests that future investigations should focus on 1) clarifying the mediators and moderators most relevant in the association between mastery and downstream disease, 2) testing the association between mastery and biological outcomes longitudinally, 3) examining the physiological impact of mastery-increasing interventions, and 4) studying the relationship between mastery and disease risk in diverse ethnic or sociocultural groups.

Cognitive adaptation theory as a means to PTSD reduction among cancer pain patients

Eighty-nine cancer pain patients participated in a study evaluating components of the Cognitive Adaptation Index on symptoms of posttraumatic stress disorder (PTSD). Positive correlations were found between optimism, mastery, and self-esteem. Inverse relationships with a PTSD symptom scale were also established. Multiple regression analyses for aggregate PTSD scores, avoidance/numbing, and arousal symptoms were each significant at p < 0.0001, intrusive symptoms at p < 0.020. Except for intrusive symptoms, self-esteem played a statistically significant mediating role for the influence of other variables. These results are discussed regarding their impact on PTSD, intervention strategies, and mental health of individuals experiencing stress.

Cognitive adaptability as a moderator of expressive writing effects in an HIV sample

This study explored the effects of expressive writing on positive and negative outcomes related to perceived psychosocial and health status among persons with HIV. This was the first study to examine the moderating effects of cognitive adaptability--consisting of dispositional optimism coupled with perceived competence--on outcomes of expressive writing. Thirty-seven participants wrote about either traumatic experiences or trivial topics in four 20-min sessions. Dependent measures obtained at baseline were repeated 1 month later. Although no main effects for group were found, baseline levels of cognitive adaptability were differentially associated with changes in a positive outcomes index, and a pain and physical functioning index in those assigned to the two groups. No moderating effects of cognitive adaptability were found for changes in a negative outcomes index. Findings underscore the importance of identification of moderating variables in understanding the impact of expressive writing interventions among individuals with HIV or other conditions.

Coregulation, Dysregulation, Self-Regulation: An Integrative Analysis and Empirical Agenda for Understanding Adult Attachment, Separation, Loss, and Recovery

An integrative framework is proposed for understanding how multiple biological and psychological systems are regulated in the context of adult attachment relationships, dysregulated by separation and loss experiences, and, potentially, re-regulated through individual recovery efforts. Evidence is reviewed for a coregulatory model of normative attachment, defined as a pattern of interwoven physiology between romantic partners that results from the conditioning of biological reward systems and the emergence of felt security within adult pair bonds. The loss of coregulation can portend a state of biobehavioral dysregulation, ranging from diffuse psychophysiological arousal and disorganization to a full-blown (and highly organized) stress response. The major task for successful recovery is adopting a self-regulatory strategy that attenuates the dysregulating effects of the attachment disruption. Research evidence is reviewed across multiple levels of analysis, and the article concludes with a series of testable research questions on the interconnected nature of attachment, loss, and recovery processes.

Placebo response in asthma: a robust and objective phenomenon

BACKGROUND

Placebos are hypothesized to exert positive effects on medical conditions by enhancing patient expectancies. Recent reviews suggest that placebo benefits are restricted to subjective responses, like pain, but might be ineffective for objective physiologic outcomes. Nevertheless, mind-body links and placebo responsivity in asthma are widely believed to exist.

OBJECTIVE

We carried out a randomized, double-blind investigation to (1) determine whether placebo can suppress airway hyperreactivity in asthmatic subjects, (2) quantify the placebo effect, (3) identify predictors of the placebo response, and (4) determine whether physician interventions modify the placebo response.

METHODS

In a double-blind, crossover design investigation, 55 subjects with mild intermittent and persistent asthma with stable airway hyperreactivity were randomized to placebo or salmeterol before serial methacholine challenges. Subjects were additionally randomized to physician interactions that communicated either positive or neutral expectancies regarding drug effect.

RESULTS

Placebo bronchodilator administration significantly reduced bronchial hyperreactivity compared with baseline (the calculated concentration of methacholine required to induce a 20% decrease in FEV(1) nearly doubled); 18% of subjects were placebo responders by using conservative definitions. Experimental manipulation of physician behavior altered perceptions of the physician but not the magnitude or frequency of the placebo response.

CONCLUSIONS

Objective placebo effects exist in asthma. These responses are of significant magnitude and likely to be meaningful clinically. The placebo response was not modulated by alterations in physician behavior in this study.

CLINICAL IMPLICATIONS

The placebo response in patients with asthma is important in understanding the limitations of clinical research studies and in maximizing safe and effective therapies. This article confirms the existence of a strong placebo response in an objective and clinically relevant measure of disease activity.

Differential effects of faith-based coping on physical and mental fatigue in middle-aged and older cardiac patients

PURPOSE

This analysis investigated the effect of faith-based coping used by cardiac patients undergoing surgery on physical and mental fatigue, symptoms which have significant prognostic implications for mortality. Particularly, we explored whether this faith effect is independent or explained by positive mediators.

METHODS

Two weeks preoperatively, 481 patients (male, 58%; mean age = 62 years) were recruited for three sequential interviews. Among them, 426 completed the second interview, and 335 completed the post-operative follow-up. Cross-clamp and bypass time were obtained from patients' charts. Plasma interlukin-6 (IL-6) was used as a correlate of age-associated diseases and frailty.

RESULTS

Hierarchical multiple regression analyses showed that pre-operative positive religious coping styles and optimism contributed to reduced physical fatigue, controlling for post-operatively confirmed prayer coping and such covariates as severe injury. Depression and lower-back problems contributed to mental fatigue. No potential mediators explained these effects.

CONCLUSION

Faith-based coping and optimism are independent predictors of physical fatigue.

Cognitive appraisals and psychological distress following venous thromboembolic disease: An application of the theory of cognitive adaptation

Venous thrombosis is a common and life-threatening disease that has received little attention in health psychology. The present study applied the theory of cognitive adaptation (TCA) to examine patients' reactions to venous thrombosis. Patients (N = 123) aged 16-84 recruited from anticoagulation units in the north of England completed measures of TCA constructs (meaning, mastery, self-esteem and optimism) and various outcome variables (anxiety, depression, thrombosis worries and quality of life) within 1 month of their thrombosis. The TCA explained large and significant amounts of variance in the outcome variables. In line with expectations, mastery, self-esteem and optimism were associated with positive adjustment. However, meaning was associated with elevated levels of distress. The results are discussed in relation to the search for meaning and the use of different control strategies in the early phases of adaptation to thrombosis.

Psychological resources protect health: 5-year survival and immune function among HIV-infected women from four US cities

OBJECTIVE

Guided by Cognitive Adaptation Theory, the aim was to determine whether psychological resources (positive affect, positive expectancy regarding health outcomes, finding meaning in challenging circumstances) protect against HIV-related mortality and decline in CD4 lymphocyte counts among women with HIV.

DESIGN

The HIV Epidemiologic Research Study, a longitudinal prospective cohort study, with semi-annual interview, physical examination and laboratory assays.

METHODS

A total of 773 HIV-seropositive women aged 16 to 55 years were recruited from four academic medical centers in Baltimore, Maryland; Bronx, New York; Providence, Rhode Island; and Detroit, Michigan. Semi-annually for up to 5 years, the women were interviewed, underwent physical examination, medical record abstraction, and venipuncture. Primary outcomes for these analyses included HIV-related mortality and CD4 cell count slope decline over 5 years.

RESULTS

Psychological resources were inversely associated with HIV-related mortality and time to death, beyond the effects of potential confounding variables such as clinical status (e.g., HIV viral load, symptoms, antiretroviral therapy), sociodemographic characteristics (e.g. age, race), and depression at study entry (P < 0.05). Psychological resources also were inversely associated with CD4+ cell count decline (P < 0.01), serving as a possible mechanism linking resources to mortality.

CONCLUSIONS

Psychological resources may protect against HIV-related mortality and immune system decline. Findings have implications for understanding individual variability in HIV disease progression. Moreover, because psychological resources are potentially amenable to change, results can be applied to clinical interventions aimed at improving the health of women with HIV.

The effects of meritocracy beliefs on women's well-being after first-time gender discrimination

This study examined how meritocracy beliefs may buffer women from the negative psychological effects of an acute situation of gender discrimination. Although some research indirectly suggests that believing that meritocracy exists may increase wellbeing, group consciousness theories suggest that disbelieving that meritocracy exists will enhance psychological adjustment to gender discrimination. Women who reported little past experience with discrimination, and either believed or disbelieved that meritocracy exists, were exposed to either a laboratory situation of discrimination or a nondiscrimination failure (control) condition. Consistent with group consciousness theories, women experiencing discrimination reported greater well-being if they disbelieved that meritocracy exists than if they were believers. In contrast, women in the control condition reported greater wellbeing if they believed that meritocracy exists than if they were disbelievers. Implications for coping with discrimination are discussed.

Engagement and arousal: optimism's effects during a brief stressor

Optimism is usually associated with better psychological and physiological adjustment to stressors, but some contradictory findings exist. The purpose of this study was to investigate how optimism could result in negative immunological changes following difficult stressors. Because optimists are likely to see positive outcomes as attainable, they may invest greater effort to achieve their goals. It is proposed that such engagement would be more physiologically demanding when pursuing difficult goals. Participants (N = 54) worked on 11 difficult or insoluble anagrams. Optimism when combined with high self-awareness increased time spent working on the anagrams and skin conductance and salivary cortisol during the recovery period. The results support the notion that the increased engagement that arises from optimism may lead to short-term physiological costs.

Optimism and immunity: do positive thoughts always lead to positive effects?

The effects of dispositional optimism, as defined by generalized positive expectations for the future, on physical health are mixed, especially in diseases that can be immunologically mediated such as HIV and cancer. Both experimental and naturalistic studies show that optimism is negatively related to measures of cellular immunity when stressors are difficult (e.g., complex, persistent, and uncontrollable) but positively related when stressors are easy (e.g., straightforward, brief, and controllable). Although the negative relationship between optimism and immunity has been attributed to the violation of optimists' positive expectancies and subsequent disappointment, empirical evidence suggests that it is more likely to be a consequence of optimists' greater engagement during difficult stressors. For example, negative mood does not account for the effect, but conscientiousness, a personality facet related to engagement, does. The mixed immunological correlates of optimism may explain why it does not consistently predict better disease outcomes.