Judith Tedlie Moskowitz

Positive affect and the other side of coping.

Although research on coping over the past 30 years has produced convergent evidence about the functions of coping and the factors that influence it, psychologists still have a great deal to learn about how coping mechanisms affect diverse outcomes. One of the reasons more progress has not been made is the almost exclusive focus on negative outcomes in the stress process. Coping theory and research need to consider positive outcomes as well. The authors focus on one such outcome, positive affect, and review findings about the co-occurrence of positive affect with negative affect during chronic stress, the adaptive functions of positive affect during chronic stress, and a special class of meaning-based coping processes that support positive affect during chronic stress.

Stress, Positive Emotion, and Coping:

There is growing interest in positive aspects of the stress process, including positive outcomes of stress and antecedents that dispose individuals to appraise stressful situations more as a challenge than as a threat. Less attention has been given to the adaptational significance of positive emotions during stress or to the coping processes that sustain positive emotions. We review evidence for the occurrence of positive emotions under conditions of stress, discuss the functional role that positive emotions play under such conditions, and present three types of coping that are associated with positive emotion during chronic stress. These findings point to new research questions about the role of positive emotions during stress and the nature of the coping processes that generate these positive emotions.

Positive affect predicts lower risk of AIDS mortality

Objective: The objective of this study was to test the association of positive affect as measured by the Center for Epidemiologic Studies Depression Scale (CES‐D) with risk of AIDS mortality, controlling for the other CES‐D subscales and laboratory measures of disease progression. Methods: Data come from the San Francisco Mens Health Study, a prospective study of a household probability sample of single men in San Francisco. The subjects were 407 men who were HIV+ at study baseline. Results: In time‐dependent Cox proportional hazards models, the positive affect subscale of the CES‐D was significantly associated with lower risk of AIDS mortality (RR = 0.89, CI = 0.84‐0.95). When risk estimates were adjusted for time‐dependent covariates of CD4, serum &bgr;2‐microglobulin, P24 antigen, antiretroviral use, and the other subscales of the CES‐D, positive affect remained significantly predictive of lower risk of AIDS mortality (RR = 0.90, CI = 0.85‐0.97). When the CES‐D subscale predictors were lagged by 12, 24, and 36 months in order to address the possibility that positive affect was simply a marker for better health, positive affect remained significantly predictive lagged by 12 months and marginally predictive lagged by 24 months. Conclusions: Positive affect seems to be the “active ingredient” in the association of scores on the CES‐D depressive mood scale and mortality in this sample of HIV+ men. Future work should expand the traditional negative‐affect‐only focus to encompass the significant role that positive affect plays in living with HIV.

Resilience to Loss in Bereaved Spouses, Bereaved Parents, and Bereaved Gay Men

Recent research has indicated that many people faced with highly aversive events suffer only minor, transient disruptions in functioning and retain a capacity for positive affect and experiences. This article reports 2 studies that replicate and extend these findings among bereaved parents, spouses, and caregivers of a chronically ill life partner using a range of self-report and objective measures of adjustment. Resilience was evidenced in half of each bereaved sample when compared with matched, nonbereaved counterparts and 36% of the caregiver sample in a more conservative, repeated-measures ipsative comparison. Resilient individuals were not distinguished by the quality of their relationship with spouse/partner or caregiver burden but were rated more positively and as better adjusted by close friends.

Suicide Attempts Among Gay and Bisexual Men: Lifetime Prevalence and Antecedents

OBJECTIVES We examined lifetime prevalence of suicide attempts and psychosocial correlates in a large population-based sample of men who have sex with men (MSM). METHODS A telephone probability sample of US urban MSM (n = 2881) were interviewed between November 1996 and February 1998. RESULTS Twenty-one percent had made a suicide plan; 12% had attempted suicide (almost half of those 12% were multiple attempters). Most who attempted suicide made their first attempt before age 25. Although prevalence of parasuicide (i.e., attempted suicide) has remained constant across birth cohorts, mean age at initial attempts has declined. CONCLUSIONS MSM are at elevated risk for suicide attempts, with such risk clustered earlier in life. Some risk factors were specific to being gay or bisexual in a hostile environment.

Coping and physical health during caregiving: the roles of positive and negative affect.

The associations among coping, mood, and health variables were examined prospectively over 2 years in 86 HIV positive (HIV+) and 167 HIV negative (HIV-) gay men undergoing the stress of AIDS-related caregiving. Path models suggested that including both positive and negative mood and the mens associated coping strategies increases understanding of why some people suffer adverse health effects during times of stress. Among the HIV- caregivers, higher levels of social coping predicted increases in positive affect, which in turn resulted in lower levels of physical symptoms. In contrast, higher levels of cognitive avoidance predicted increases in negative affect, which in turn resulted in higher levels of physical symptoms. Self-injurious forms of avoidance coping predicted higher levels of physical symptoms independent of mood among the HIV+ caregivers.

Coping and mood during AIDS-related caregiving and bereavement.

This prospective study of a cohort of human immunodeficiency virus positive (HIV+) and HIV negative (HIV-) caregiving partners of men with AIDS examined the contextual effects of caregiving and bereavement on coping and the association between coping and positive and negative mood during the five months leading up to their partners death and the five months following their partners death. Participants used more problem-focused types of coping and more cognitive escape avoidance during caregiving than during bereavement. Six of the eight types of coping that were assessed were associated with negative mood, controlling for prior negative mood. These associations differed as a function of context (caregiving versus bereavemenO. Five types of coping were associated with positive mood, controlling for prior positive mood. HIV serostatus did not affect the relation between coping and mood.

Can Meditation Slow Rate of Cellular Aging? Cognitive Stress, Mindfulness, and Telomeres

Understanding the malleable determinants of cellular aging is critical to understanding human longevity. Telomeres may provide a pathway for exploring this question. Telomeres are the protective caps at the ends of chromosomes. The length of telomeres offers insight into mitotic cell and possibly organismal longevity. Telomere length has now been linked to chronic stress exposure and depression. This raises the question of mechanism: How might cellular aging be modulated by psychological functioning? We consider two psychological processes or states that are in opposition to one another–threat cognition and mindfulness–and their effects on cellular aging. Psychological stress cognitions, particularly appraisals of threat and ruminative thoughts, can lead to prolonged states of reactivity. In contrast, mindfulness meditation techniques appear to shift cognitive appraisals from threat to challenge, decrease ruminative thought, and reduce stress arousal. Mindfulness may also directly increase positive arousal states. We review data linking telomere length to cognitive stress and stress arousal and present new data linking cognitive appraisal to telomere length. Given the pattern of associations revealed so far, we propose that some forms of meditation may have salutary effects on telomere length by reducing cognitive stress and stress arousal and increasing positive states of mind and hormonal factors that may promote telomere maintenance. Aspects of this model are currently being tested in ongoing trials of mindfulness meditation.

Positive affect uniquely predicts lower risk of mortality in people with diabetes.

OBJECTIVE To determine whether positive affect predicts mortality among people with diabetes and among a comparison group of people with no chronic health conditions. DESIGN Longitudinal cohort study. MAIN OUTCOME MEASURE Mortality. RESULTS Positive affect was significantly associated with lower risk of all-cause mortality in people with diabetes (N = 715). Enjoyed life was associated with lower risk of mortality over and above the effects of negative affect or other significant predictors of mortality. In a comparison sample without chronic illness (N = 2,673), positive affect was not associated with mortality. However, when the analysis was restricted to those over the age of 65, specific positive affects, in particular hopeful and enjoyed life were significantly associated with lower risk of mortality, again independent of negative affect. Enjoyed life remained significantly predictive of lower risk of mortality in the older sample when other predictors of mortality were statistically controlled. Positive affect was particularly protective among those over the age of 65 who reported higher levels of stress. CONCLUSION These findings are discussed in light of possible stress-buffering functions of positive affect.

Positive Meaningful Events and Coping in the Context of HIV/AIDS

Most research on coping with chronic stress tends to focus inquiry on strategies that help the person manage stressor-related demands. In the case of coping with a debilitating illness, for example, the search often focuses on strategies that are related to managing the primary consequences of the illness, including disease-related limited mobility, pain, or dysphoria, and the secondary consequences of the illness, including disrupted family relationships or changes in role functioning. However, the lives of people with a debilitating illness consist of more than just their illness. They may have warm family relationships, friends with whom they talk, or work or other activities that interest them. These other aspects of people’s lives may play an important role in sustaining their well-being while they are coping with their illness. Thus, a full understanding of the coping process in the context of chronic stress may need to take into account aspects of people’s lives that at first blush do not seem to be related directly to how they cope with the chronic stress per se.