Repression following a series of natural disasters: Immune and Neuroendocrine correlates

Which symptoms matter? Self-report and observer discrepancies in repressors and high-anxious women with metastatic breast cancer

Clinicians working with cancer patients listen to them, observe their behavior, and monitor their physiology. How do we proceed when these indicators do not align? Under self-relevant stress, non-cancer repressors respond with high arousal but report low anxiety; the high-anxious report high anxiety but often have lower arousal. This study extends discrepancy research on repressors and the high-anxious to a metastatic breast cancer sample and examines physician rating of coping. Before and during a Trier Social Stress Test (TSST), we assessed affect, autonomic reactivity, and observers coded emotional expression from TSST videotapes. We compared non-extreme (N = 40), low-anxious (N = 16), high-anxious (N = 19), and repressors (N = 19). Despite reported low anxiety, repressors expressed significantly greater Tension or anxiety cues. Despite reported high anxiety, the high-anxious expressed significantly greater Hostile Affect rather than Tension. Physicians rated both groups as coping significantly better than others. Future research might productively study physician-patient interaction in these groups.

Salivary cortisol among American Indians with and without posttraumatic stress disorder (PTSD): gender and alcohol influences

Disruptions in hypothalamic-pituitary-adrenal regulation and immunity have been associated with posttraumatic stress disorder (PTSD). We examined the association of PTSD with diurnal rhythms in salivary cortisol in a convenience sample from a population-based study of male and female American Indians. Subjects with and without PTSD were identified from American Indians living on/near a Northern Plains reservation as part of a larger study. Over two days diurnal saliva samples were collected by staff at the University of Colorado Denver Clinical Research Center at waking, 30min after waking, before lunch, and before dinner. Generalized estimating equations linear regression models investigated the influence of PTSD on cortisol over time. The association of a lifetime diagnosis of PTSD with salivary cortisol level was assessed in subjects with complete data (PTSD: n=27; no PTSD n=32) for age, gender, and alcohol consumption in the past month. Subject mean age was 44 years, and 71% were women. When stratified by gender, women with a lifetime diagnosis of PTSD had significantly higher mean cortisol levels throughout the day than women without PTSD (p=0.01); but there was no significant association between PTSD and cortisol levels in men (p=0.36). The cortisol awakening response - the difference in cortisol levels from waking to 30min after waking - was not associated with PTSD in men or women. A lifetime diagnosis of PTSD may influence diurnal cortisol among American Indian women. These effects were independent of influences of current alcohol use/abuse. The unexpected elevation in cortisol in American Indian women with a lifetime diagnosis of PTSD may reflect acute anxiety associated with experiencing a number of novel tests in a strange location (e.g., cardiac imaging, medical, dental exams, etc.), or concurrent depression.

Verbal-autonomic response dissociations as traits?

Dissociations between subjective and physiological responses to stress are of central interest in coping research. However, little is known about their stability across situations and time. Two experimental sessions - separated by 1 year - were conducted to examine cross-situational consistency and longterm-stability of HR-derived and SCL-derived dissociation scores. In year 1, a speech stressor, the cold pressor and a video stressor (viewing of the speech video) were applied. In year 2, mental arithmetics, anagrams and a torture video were presented. Thirty-five students participated and HR, SCL and negative affect were recorded. For each stressor, standardized changes in negative affect were subtracted from changes in autonomic reactivity (HR and SCL, respectively). Dissociation scores were relatively consistent across the stressors with HR-derived scores exceeding SCL-derived scores. Longterm-stability proved acceptable (r=.61, P<.001 for HR-derived and r=.40, P<.05 for SCL-derived scores). In sum, verbal-autonomic response dissociations show considerable cross-situational and temporal stability and thus might be considered as traits.