Carissa A. Low

Expressive disclosure and benefit finding among breast cancer patients: mechanisms for positive health effects.

A randomized trial (n = 60; A. L. Stanton, S. Danoff-Burg, L. A. Sworowski, et al., 2002) revealed that 4 sessions of written expressive disclosure or benefit finding produced lower physical symptom reports and medical appointments for cancer-related morbidities at 3-month follow-up among breast cancer patients relative to a fact-control condition. The goal of this article is to investigate mechanisms underlying these effects. Within-session heart rate habituation mediated effects of expressive disclosure on physical symptoms, and greater use of negative emotion words in essays predicted a decline in physical symptoms. Postwriting mood and use of positive emotion and cognitive mechanism words in essays were not significant mediators, although greater cognitive mechanism word use was related to greater heart rate habituation and negative emotion word use.

A Randomized Controlled Trial of Emotionally Expressive Writing for Women With Metastatic Breast Cancer

OBJECTIVE To test the effects of emotionally expressive writing in a randomized controlled trial of metastatic breast cancer patients and to determine whether effects of the intervention varied as a function of perceived social support or time since metastatic diagnosis. DESIGN Women (N = 62) living with Stage IV breast cancer were randomly assigned to write about cancer-related emotions (EMO; n = 31) or the facts of their diagnosis and treatment (CTL; n = 31). Participants wrote at home for four 20-min sessions within a 3-week interval. MAIN OUTCOME MEASURES Depressive symptoms, cancer-related intrusive thoughts, somatic symptoms, and sleep quality at 3 months postintervention. RESULTS No significant main effects of experimental condition were observed. A significant condition x social support interaction emerged on intrusive thoughts; EMO writing was associated with reduced intrusive thoughts for women reporting low emotional support (eta2 = .15). Significant condition x time since metastatic diagnosis interactions were also observed for somatic symptoms and sleep disturbances. Relative to CTL, EMO participants who were more recently diagnosed had fewer somatic symptoms (eta2 = .10), whereas EMO participants with longer diagnosis duration exhibited increases in sleep disturbances (eta2 = .09). CONCLUSION Although there was no main effect of expressive writing on health among the current metastatic breast cancer sample, expressive writing may be beneficial for a subset of metastatic patients (including women with low levels of emotional support or who have been recently diagnosed) and contraindicated for others (i.e., those who have been living with the diagnosis for years).

Negative Affective Responses to a Speech Task Predict Changes in Interleukin(IL)-6

Laboratory studies show that individuals differ appreciably in the magnitude of their inflammatory responses to acute psychological stress. These individual differences are poorly understood, yet may contribute to variation in stress-associated disease vulnerability. The present study examined the possibility that affective responses to acute stress contribute to these differences. For this purpose, 102 relatively-healthy community volunteers (mean age 50 years; 60% female; 91.2% white) performed an acute stress protocol and measures of affective state and serum levels of the proinflammatory cytokine, interleukin (IL)-6 were collected at the end of a 30-min resting baseline, a 5-min evaluative public speaking task, and a 30-min recovery period. Results of regression analyses, controlling for age, race, gender, menopausal status, and body mass index, revealed a positive association of task-related increases in anger and anxiety with increases in IL-6 (R² change = .08, p = .004; R² change = .08, p = .005, respectively). Further examination showed that these affective responses to the task were independent predictors of change in IL-6. Cardiovascular reactivity to the task did not explain the association. These results suggest that individuals who exhibit angry or anxious responses to acute challenge are more vulnerable to stress-related increases in markers of systemic inflammation, possibly rendering them more susceptible to inflammatory disease.

Chronic Life Stress, Cardiovascular Reactivity, and Subclinical Cardiovascular Disease in Adolescents

Objective: To examine cross-sectional and longitudinal relationships between chronic life stress, cardiovascular reactivity, and a marker of subclinical cardiovascular disease in a multiethnic sample of adolescents. Methods: Participants were 158 healthy adolescents who completed self-report measures of chronic negative life stress as well as assessments of heart rate and blood pressure reactivity to acute laboratory stressors at two time points, approximately 3.3 years apart. At Time 2, intima-media thickness (IMT), a measure of subclinical atherosclerosis, was also measured. Results: In hierarchical regression models adjusting for demographic variables and body mass index, chronic negative life stress at Time 2 was concurrently associated with greater diastolic blood pressure (DBP) reactivity to stress (&bgr; = 0.18, p = .016), but neither chronic stress nor cardiovascular reactivity was associated concurrently with IMT. Increasing life stress from Time 1 to Time 2 was accompanied by increasing cardiovascular reactivity (&bgr; = 0.14–0.20, p < .05), and increasing DBP reactivity over time was also associated with IMT (&bgr; = 0.24, p = .03), although increasing chronic life stress was not directly related to IMT. Conclusions: Adolescents exposed to chronic, negative stressors that worsen over time may show heightened cardiovascular reactivity that puts them at risk for subclinical atherosclerosis. BMI = body mass index; CVD = cardiovascular disease; DBP = diastolic blood pressure; ECG = electrocardiogram; HR = heart rate; IMT = intima media thickness; SBP = systolic blood pressure.

Benefit Finding in Response to BRCA1/2 Testing

BackgroundUndergoing genetic testing for BRCA1/2 mutations may be accompanied by elevated worry and distress, but the potential for the experience to catalyze positive psychological and life changes has not been studied.PurposeThis study was designed to examine the relationship between mutation carrier status, personal cancer history, and the potential positive impact of genetic testing (i.e., benefit finding). We also tested two predictors of benefit finding (BF) derived from the theoretical and empirical literature on positive outcomes of stress: impact of the experience and approach-oriented coping.MethodsWomen undergoing genetic testing for BRCA1/2 mutations (n = 108) completed questionnaires assessing test-related distress, approach-oriented coping, and BF after receipt of test results. BRCA1/2 status was determined from genetic test results and personal cancer history from interviews conducted with study participants before testing.ResultsReports of BF in this sample were highly variable, as some women did not perceive the testing experience as having any noticeable effect on their lives, whereas others reported positive changes similar to those observed in cancer patients (e.g., significantly improved relationships, greater appreciation for life). Contrary to hypotheses, women who tested positive for BRCA1/2 did not report higher levels of BF in response to genetic testing than those who tested negative. However, BF scores were elevated among mutation carriers who had a previous cancer diagnosis. As predicted, test-related distress and approach-oriented coping were also positively associated with BF, and approach-oriented coping mediated the relationship between carrier status × cancer history and BF.ConclusionsFindings suggest that positive life changes can occur among women who test positive for BRCA1/2 mutations, particularly cancer survivors.

Expressing Emotions in Stressful Contexts Benefits, Moderators, and Mechanisms

Historically, research has suggested that coping with stress by expressing emotions is maladaptive. With improved conceptualization and assessment of stressor-related emotional expression, more recent research has revealed that emotional expression can promote well-being in individuals who are under stress. Characteristics of stressors, individuals, social contexts, and the emotional expressions themselves determine whether emotionally expressive coping is beneficial. Identifying who benefits from emotional expression in which contexts and how the positive effects of emotionally expressive coping accrue can inform theories of coping and emotion and further the development of interventions for populations undergoing stress.

Psychosocial predictors of coronary artery calcification progression in postmenopausal women.

Objective: Coronary artery calcification (CAC) has been associated with psychosocial factors in some but not all cross-sectional analyses. The goal of this study was to determine whether positive and negative psychosocial factors prospectively predict CAC progression in postmenopausal women. Methods: Participants from the Healthy Women Study who also participated in the Pittsburgh Mind-Body Center protocol (n = 149) completed self-report psychosocial measures before two electron beam computed tomographic scans of CAC separated by an average of 3.3 years. Results of exploratory factor analysis were used to create aggregate psychosocial indices: psychological risk (depressive symptoms, perceived stress, cynicism, and anger-in) and psychosocial resources (optimism, purpose in life, mastery, self-esteem, and social support). Results: The psychological risk index predicted significantly greater CAC progression over 3 years (&bgr; = 0.16, p = .035, &Dgr;R2 = 0.03), whereas the psychosocial resources index was not predictive of CAC progression (&bgr; = −0.08, p = .30, &Dgr;R2 = 0.01). On individual scales, higher scores on cynicism emerged as a significant predictor of CAC progression, along with a trend linking anger-in to atherosclerosis progression. A post hoc analysis showed a significant interaction between cynicism and anger-in (&bgr; = 0.20, p = .01, &Dgr;R2 = 0.03), such that women reporting high levels of both cynicism and anger suppression exhibited the most CAC progression. Conclusions: These findings highlight psychosocial risk factors that may accelerate the progression of subclinical atherosclerosis in older women, suggest the potential importance of examining combinations of psychosocial risk factors, and identify potential targets for psychological interventions to reduce cardiovascular risk.CAC = coronary artery calcification; CVD = cardiovascular disease; EBCT = electron beam computed tomography; HWS = Healthy Women Study; IMT = intima-media thickness; PMBC = Pittsburgh Mind-Body Center

Dispositional and Stressor-Related Emotion Regulation in the Context of a Chronic, Life-Limiting Stressor

In the context of efforts to regulate emotion during chronic stressors, both dispositional response tendencies (affect intensity, negative and positive expressivity) and stressor-related coping through emotional approach (processing and expressing emotions) are relevant to adjustment. In women with metastatic breast cancer (N = 103), contributions of self-reported emotional processing and expression related to cancer, as well as dispositional expressivity to adaptive outcomes across 3 months were examined. In the context of high dispositional expressivity, an increase in emotional expression predicted improvements in depressive symptoms and life satisfaction. Emotional processing at study entry predicted increased depressive symptoms and intrusive thoughts, and declining life satisfaction among highly expressive women. Increasing emotional processing predicted improved depressive symptoms in the context of high expressivity. Increases in emotional approach coping were associated with a more arduous cancer experience. Findings highlight the importance of the person-situation fit in linking emotion-related constructs to adjustment during unremitting stressors.

Elevated C-reactive protein in adolescents: roles of stress and coping.

Objective Psychological stress can up-regulate inflammatory processes and increase disease risk. In the context of stress, differences in how individuals cope might have implications for health. The goal of this study was to evaluate associations among stress, coping, and inflammation in a sample of African American and white adolescents. Methods Adolescents (n = 245) completed self-report measures of stressful life events and coping, provided daily diary reports of interpersonal conflict for 7 days, and provided fasting blood samples for assessment of C-reactive protein (CRP). Results In regression analyses adjusted for age, sex, race, body mass index, smoking, and socioeconomic status, there were no significant associations between stress and CRP, but significant interactions between stress and coping emerged. For adolescents reporting more unpleasant stressful life events in the past 12 months, positive engagement coping was inversely associated with CRP (&bgr;= −.19, p < .05), whereas coping was not significantly associated with CRP for adolescents reporting fewer stressful life events. Positive engagement coping was significantly and inversely associated with CRP in the context of interpersonal stress, whether measured as stressful life events reflecting interpersonal conflict (e.g., arguments with parents or siblings, conflict between adults in the home, and friendship ended) or frequency of arguments with others reported in daily diaries. Disengagement coping was unrelated to CRP. Conclusions Findings suggest that positive engagement coping is associated with lower levels of inflammation, but only when adolescents are challenged by significant stress.

Association between C-reactive protein and depressive symptoms in women with rheumatoid arthritis.

Converging lines of evidence support an association between systemic inflammation and depressive symptoms. Neuroimmune pathways may account for the high prevalence of depression in individuals with inflammatory conditions such as rheumatoid arthritis (RA). However, this relationship is complicated by factors linked to both inflammatory disease activity and mood, such as pain and physical disability. The goal of this cross-sectional study was to examine the relationship between C-reactive protein (CRP) and depressive symptoms among 173 women with RA. Somatic symptoms of depression and circulating CRP were significantly associated in regression analyses adjusted for body mass index (beta=.19, p<.05), but this relationship was attenuated when pain and disability were included as covariates (beta=.09, p=.24). CRP was not significantly associated with negative mood symptoms of depression. Findings suggest that depression in the context of RA may result from the overlap of somatic depressive and RA symptoms rather than neuroimmune pathways.