Ann O'Leary

STRESS, EMOTION, AND HUMAN IMMUNE FUNCTION

This article provides a review of empirical evidence linking emotional processes to immune function in humans. Acute stressors have produced mixed effects on immunity, presumably through differential activation of physiological stress systems. Chronic stress has been associated with suppression of immune function, and there is evidence that the immune system may not adapt over time. Effects of stress accompanying social disruption and psychological depression, when demonstrated, have been consistently adverse. Certain personality styles may enhance or degrade immune response. Relationships between psychosocial factors and immunity have been identified for several diseases, including cancer, acquired immune deficiency syndrome, and autoimmune diseases; psychosocial interventions have been tested with variable results. Theoretical and methodological considerations are summarized and directions for future research suggested.

Perceived self-efficacy and pain control: Opioid and nonopioid mechanisms.

In this experiment, we tested for opioid and nonopioid mechanisms of pain control through cognitive means and the relation of opioid involvement to perceived coping efficacy. Subjects were taught cognitive methods of pain control, were administered a placebo, or received no intervention. Their pain tolerance was then measured at periodic intervals after they were administered either a saline solution or naloxone, an opiate antagonist that blocks the effects of endogenous opiates. Training in cognitive control strengthened perceived self-efficacy both to withstand and to reduce pain; placebo medication enhanced perceived efficacy to withstand pain but not reductive efficacy; and neither form of perceived self-efficacy changed without any intervention. Regardless of condition, the stronger the perceived self-efficacy to withstand pain, the longer subjects endured mounting pain stimulation. The findings provide evidence that attenuation of the impact of pain stimulation through cognitive control is mediated by both opioid and nonopioid mechanisms. Cognitive copers administered naloxone were less able to tolerate pain stimulation than were their saline counterparts. The stronger the perceived self-efficacy to reduce pain, the greater was the opioid activation. Cognitive copers were also able to achieve some increase in pain tolerance even when opioid mechanisms were blocked by naloxone, which is in keeping with a nonopioid component in cognitive pain control. We found suggestive evidence that placebo medication may also activate some opioid involvement. Because placebos do not impart pain reduction skills, it was perceived self-efficacy to endure pain that predicted degree of opioid activation.

A cognitive-behavioral treatment for rheumatoid arthritis.

This experiment tested a cognitive-behavioral rheumatoid arthritis treatment designed to confer skills in managing stress, pain, and other symptoms of the disease. We hypothesized that a mediator of the magnitude of treatment effects might be enhancement of perceived self-efficacy to manage the disease. It was predicted that the treatment would reduce arthritis symptoms and possibly would improve both immunologic competence and psychological functioning. The treatment provided instruction in self-relaxation, cognitive pain management, and goal setting. A control group received a widely available arthritis helpbook containing useful information about arthritis self-management. We obtained suggestive evidence of an enhancement of perceived self-efficacy, reduced pain and joint inflammation, and improved psychosocial functioning in the treated group. No change was demonstrated in numbers or function of T-cell subsets. The magnitude of the improvements was correlated with degree of self-efficacy enhancement.

Impact of Perceived Self-Efficacy in Coping With Stressors on Components of the Immune System

This experiment examined the impact of experimentally varied perceived self-efficacy in exercising control over stressors on components of the immunological system. Immunological changes while coping with phobic stressors were measured within an intrasubject control design that included a baseline phase, an efficacy-acquisition phase, and a maximal-efficacy phase. In each of these phases, perceived coping self-efficacy, level of autonomic and endocrine activation, and several components of the immunological system were measured. Development of strong perceived self-efficacy to control phobic stressors had an immunoenhancing effect. A slow growth of perceived self-efficacy, heart rate acceleration, and cortisol activation attenuated immunological system status during the efficacy-acquisition phase. Rapid growth of perceived self-efficacy also predicted maintenance of immunoenhancement during the maximal perceived self-efficacy phase.

From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention.

From Child Sexual Abuse to Adult Sexual Risk: An Introduction to the Issues Childhood Sexual Abuse and Adult Sexual Relationships: Review and Perspective Childhood Sexual Abuse and Adult Sexual Revictimization Sexual Abuse of Girls and HIV Infection Among Women: Are They Related? Sexual Abuse of Boys: Short- and Long-Term Associations and Implications for HIV Prevention Cognitive and Attitudinal Paths From Childhood Trauma to Adult HIV Risk The Link Between Childhood Sexual Abuse and Risky Sexual Behavior: The Role of Dissociative Tendencies, Information-Processing Effects, and Consensual Sex Decision Mechanisms Toward a Social-Narrative Model of Revictimization Childhood Sexual Abuse and Alcohol Use Among Women: Setting the Stage for Risky Sexual Behavior Translating Traumatic Experiences into Language: Implications for Childhood Abuse and Long-Term Health Integrating HIV/AIDS Prevention Activities into Psychotherapy for Sexual Abuse Survivors Child Sexual Abuse and HIV: An Integrative Risk-Reduction Approach Trauma-Focused Versus Present-Focused Models of Group Therapy for Women Sexually Abused in Childhood Sexual Assault Revictimization: Toward Effective Risk Reduction Programs Child Sexual Abuse and Adult Sexual Risk: Where Do We Go From Here?

Self-efficacy and health: Behavioral and stress-physiological mediation.

Perceived self-efficacy refers to peoples beliefs regarding their own abilities. Such perceptions are believed to be strong determinants of behavioral and emotional processes, and as such, these self-efficacy beliefs constitute a fundamental component of social cognitive theory (SCT). Applications of self-efficacy theory to health have demonstrated its utility across a wide range of actual and potential health outcomes. Two pathways for self-efficacy influence on health are reviewed here. One involves its effect upon the adoption of behaviors that are related to health outcomes. The other concerns its role in the physiological stress response, which exerts effects on health and illness independently of the effects of health behaviors. In the first category, efficacy influences upon two representative behaviors—cigarette smoking and condom use—are reviewed. In the second, studies exploring efficacy effects on several components of the stress response, including the sympathetic adrenomedullary, hypothalamic pituitary adrenocortical, endogenous opioid, and immune systems are described. Finally, methodological considerations and directions for future research are discussed.

Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men

Previous studies have indicated an association between childhood sexual abuse (CSA) and adult sexual risk behaviour among women and among men who have sex with men (MSM). However, no studies to date have tested the hypothesis that a history of CSA predicts sexual behaviour carrying risk of transmission of HIV to others, i.e. in a known HIV-positive cohort. The present study tested this hypothesis among a sample of 456 HIV-positive MSM recruited from community venues in New York and San Francisco. CSA history was found to be significantly associated with past (in the last 90 days) unprotected anal sex acts, both insertive (33% versus 20%, p<0.05) and receptive (43% versus 27%, p<0.02), with partners of HIV-negative or unknown serostatus. Further, several potential mediators of this effect were tested, and three found to be predicted by CSA history. Each of these potential mediators was associated with sexual risk behaviour, but differentially: anxiety and hostility were significantly associated with insertive acts, while anxiety, hostility and suicidality were associated with receptive acts. Mediation analyses supported the hypothesis that these factors significantly (albeit partially) accounted for the association of CSA with receptive anal intercourse. Nonsignificant mediation effects were found for insertive sex, suggesting the operation of unmeasured mediating variables. These results highlight the importance of mental health services for individuals who have been sexually abused, both for personal and for public health benefit, and also indicate a need for further research into mediators of CSA effects on transmission-related behaviour.

The Efficacy of HIV/STI Behavioral Interventions for African American Females in the United States: A Meta-Analysis

OBJECTIVES We evaluated the efficacy of HIV behavioral interventions for African American females in the United States, and we identified factors associated with intervention efficacy. METHODS We conducted a comprehensive literature review covering studies published from January 1988 to June 2007, which yielded 37 relevant studies. Data were analyzed using mixed-effects models and meta-regression. RESULTS Overall, behavioral interventions had a significant impact on reductions in HIV-risk sex behaviors (odds ratio [OR] = 0.63; 95% confidence interval [CI] = 0.54, 0.75; n = 11 239; Cochrane Q(32) = 84.73; P < .001) and sexually transmitted infections (STIs; OR = 0.81; 95% CI = 0.67, 0.98; n = 8760; Cochrane Q(16) = 22.77; P = .12). Greater intervention efficacy was observed in studies that specifically targeted African American females used gender- or culture-specific materials, used female deliverers, addressed empowerment issues, provided skills training in condom use and negotiation of safer sex, and used role-playing to teach negotiation skills. CONCLUSIONS Behavioral interventions are efficacious at preventing HIV and STIs among African American females. More research is needed to examine the potential contribution of prevention strategies that attend to community-level and structural-level factors affecting HIV infection and transmission in this population.

Women at Risk for HIV from a Primary Partner: Balancing Risk and Intimacy

Abstract Women are being devastated by the HIV/AIDS epidemic in the U.S. and all over the world, most infections occurring via heterosexual activity with a primary partner. Although a number of evaluations of behavioral risk-reduction interventions for women have been reported, many suffer from methodological problems that weaken confidence in their findings. It is clear that, despite statistically significant intervention effects, many women are unable to respond to even the most effective interventions that have been tested, a fact that might be attributable to failure to change behavior with primary partners. Achieving consistent condom use with primary partners can be highly challenging for women, for a variety of reasons. In the present paper, I review the literature regarding behavioral interventions for women. I also review data supporting the feasibility of alternative strategies that may be more effective than those usually recommended for women at risk for HIV infection by their primary male partner. The literature on woman-controlled technologies, such as the female condom and vaginal microbicides, is summarized. Alternative messages for condom negotiation and “negotiated safety” are also described. Because it is relevant to negotiated safety, and at the heart of the present topic, a review of the behavioral literature regarding serodiscordant heterosexual couples is also provided.

Mediation Analysis of an Effective Sexual Risk-Reduction Intervention for Women : The Importance of Self-Efficacy

OBJECTIVE Sister-to-Sister: The Black Womens Health Project is a skill-building HIV/STD risk-reduction intervention for African American women that had significant effects in reducing self-reported sexual risk behavior and biologically confirmed sexually transmitted disease (STD) incidence. The present analyses were conducted to identify which theory-based factors that were addressed in the intervention accounted for its success. DESIGN The data were collected in the context of a randomized, 5-group intervention trial with assessments at baseline and at 3, 6, and 12 months following the intervention. A mediation analysis was conducted with condom use at last sex, self-reported 12 months after the intervention, as the outcome variable. Mediators were also measured at the 12-month follow-up. MAIN OUTCOME MEASURES Mediators were derived from social cognitive theory: condom use knowledge, hedonistic beliefs regarding effects of condom use, expected sex partner reactions to condom requests, sex partner approval of condom use, self-efficacy for impulse control, self-efficacy for carrying condoms, and self-efficacy to achieve consistent condom use with partner. RESULTS The intervention significantly improved all potential mediators except condom use knowledge (p = .15), hedonistic beliefs (p = .08), and self-efficacy for impulse control (p = .20). Analyses testing each mediator separately revealed that expected partner reaction, partner approval of condom use, self-efficacy for condom carrying, and self-efficacy for condom use were significant mediators. When they were entered into a multivariate mediation analysis, however, only self-efficacy for condom use was significant (p = .001). CONCLUSION These results highlight the importance of self-efficacy in explaining the effects of skill-building sexual risk-reduction interventions on womens use of condoms. Self-efficacy was more important than characteristics of male partners.