Stacy Cruess

Cognitive-behavioral stress management reduces distress and 24-hour urinary free cortisol output among symptomatic HIV-infected gay men

BackgroundStress management interventions can reduce symptoms of distress as well as modulate certain immune system components in persons infected with human immunodeficiency virus (HIV). These effects may occur in parallel with reductions in hypothalamic-pituitary-adrenal (HPA) axis hormones such as cortisol, which has been related in other work to a down-regulation of immune system components relevant to HIV infection. The present study tested the effects of a multimodal cognitive-behavioral stress management (CBSM) intervention on 24-hour urinary free cortisol levels and distressed mood in symptomatic HIV+ gay men.MethodsSymptomatic HIV-infected gay men who were randomized to either a 10-week group-based CBSM intervention or a 10-week wait-list period provided psychological responses and urine samples pre-post intervention.ResultsOf the 59 participants providing matched questionnaire data, men assigned to CBSM (n=40) showed significantly lower posttreatment levels of self-reported depressed affect, anxiety, anger, and confusion than those in the wait-list control group (n=19). Among the 47 men providing urine samples (34 CBSM, 13 controls), those assigned to CBSM revealed significantly less cortisol output as compared to controls. At the individual level, depressed mood decreases paralleled cortisol reductions over this period across the entire sample.ConclusionA time-limited CBSM intervention reduced distress symptoms and urinary free cortisol output in symptomatic HIV+ gay men and greater reductions in some aspects of distress, especially depressed mood, paralleled greater decreases in cortisol over the intervention period. If persisting stressors and depressed mood contribute to chronic HPA axis activation in HIV-infected persons, then interventions such as CBSM, which teaches them to relax, alter cognitive appraisals, use new coping strategies, and access social support resources, may decrease distress and depressed mood and normalize HPA axis functioning.

Reductions in herpes simplex virus type 2 antibody titers after cognitive behavioral stress management and relationships with neuroendocrine function, relaxation skills, and social support in HIV-positive men

Objective Coinfection with herpes simplex virus type 2 (HSV-2) is common in individuals infected with human immunodeficiency virus (HIV) and may have health implications. This study examined the effect of a 10-week cognitive behavioral stress management (CBSM) intervention on immunoglobulin G (IgG) antibody titers to HSV-2 in a group of mildly symptomatic HIV-infected gay men and the degree to which these effects were mediated by psychosocial and endocrine changes during the 10-week period. Methods Sixty-two HIV+ gay men were randomly assigned to either a 10-week CBSM intervention (N = 41) or a wait-list control condition (N = 21). Anxious mood, social support, cortisol/dehydroepiandrosterone sulfate (DHEA-S) ratio levels, and HSV-2 IgG antibody titers were assessed at baseline and after the 10-week period. CBSM participants also recorded their stress levels before and after at-home relaxation practice. Results HSV-2 IgG titers were significantly reduced in the CBSM participants but remained unchanged in the control group after the 10-week intervention period. Increases in one type of social support, perceived receipt of guidance, during the 10 weeks was associated with and partially mediated the effect of the intervention on HSV-2 IgG. Similarly, decreases in cortisol/DHEA-S ratio levels were associated with decreases in HSV-2 IgG, and lower mean stress levels achieved after home relaxation practice were associated with greater decreases in HSV-2 IgG among CBSM participants. Conclusions These findings suggest that behavioral and psychosocial changes occurring during CBSM interventions, including relaxation, enhanced social support, and adrenal hormone reductions, may help to explain the effects of this form of stress management on immune indices such as HSV-2 antibody titers.

Changes in mood and depressive symptoms and related change processes during cognitive-behavioral stress management in HIV-infected men

This study examined the effects of a cognitive–behavioral stress management (CBSM) intervention vs. a no-treatment control group in 100 HIV-infected gay men. CBSM participants showed significant decreases in mood disturbance and depressive symptoms as well as changes in coping, perceptions of social support, self-efficacy, and dysfunctional attitudes. Stepwise regression analyses were conducted to determine which of these changes were most important for reductions in mood disturbance and depressive symptoms. Although increases in self-efficacy emerged as a significant predictor of reduction in both mood disturbance and depressive symptoms, improvements in behavioral coping strategies were most closely tied to lowered overall mood disturbance whereas improvements in cognitive coping strategies and reduction in dysfunctional attitudes were more closely associated with decreases in depressive symptoms. These results support the use of multimodal CBSM interventions for HIV-infected men as a way to modify many different types of processes independently associated with different indicators of psychological adjustment.

Cognitive-behavioral stress management increases free testosterone and decreases psychological distress in HIV-seropositive men

The effects of a 10-week group-based cognitive-behavioral stress management (CBSM) intervention on psychological distress and plasma free testosterone in symptomatic, HIV-seropositive men were examined. Participants were randomized to either CBSM (n = 42) or a wait-list control group (n = 23). Men in the CBSM intervention showed significant increases in testosterone, whereas control participants showed significant decreases. Those participating in CBSM had significant distress reductions, whereas controls showed no such change. Alterations in free testosterone were inversely related to changes in distress states over time, independent of any changes in cortisol. These findings demonstrate that a short-term CBSM intervention increases free testosterone levels among symptomatic, HIV-seropositive men, and alterations in free testosterone are associated with changes in psychological distress observed during CBSM.

A pilot study of cognitive behavioral stress management effects on stress, quality of life, and symptoms in persons with chronic fatigue syndrome.

OBJECTIVE The present pilot study was designed to test the effects of a 12-week group-based cognitive behavioral stress management (CBSM) intervention on stress, quality of life, and symptoms in chronic fatigue syndrome (CFS). We hypothesized that participants randomized to CBSM would report improvements in perceived stress, mood, quality of life, and CFS symptomatology from pre- to postintervention compared to those receiving a psychoeducational (PE) seminar control. METHOD We recruited 69 persons with a bona fide diagnosis of CFS and randomized 44 to CBSM and 25 to PE. Participants completed the Perceived Stress Scale (PSS), Profile of Mood States (POMS), Quality of Life Inventory (QOLI), and a Centers for Disease Control (CDC)-based CFS symptom checklist pre- and postintervention. RESULTS Repeated measures analysis of variance revealed a significant Group×Time interaction for PSS, POMS-total mood disturbance (TMD), and QOLI scores, such that participants in CBSM evidenced greater improvements than those in PE. Participants in CBSM also reported decreases in severity of CFS symptoms vs. those in PE. CONCLUSIONS Results suggest that CBSM is beneficial for managing distress, improving quality of life, and alleviating CFS symptom severity.

Optimism, distress, and immunologic status in HIV-infected gay men following hurricane andrew

This study investigated how dispositional optimism relates to psychological and immunologic status in 40 HIV-infected gay men residing in areas of South Florida hard hit by Hurricane Andrew. In the months following the storm, participants’ levels of psychological distress (hurricane-related and overall distress) and antibody titers to several herpesviruses (Herpes Simplex Virus-2, Epstein-Barr Virus [EBV], Cytomegalovirus, and Human Herpes Virus-6 [HHV-6]) were measured. Overall, participants had elevated mean levels of hurricane-specific and general distress. Higher levels of optimism were related to lower levels of depression, overall distress, and hurricane-specific posttraumatic stress disorder symptoms. After controlling for nonspecific polyclonal B cell activation, greater optimism was also associated with lower levels of circulating antibodies to EBV and HHV-6, suggesting better cellular immunologie control over these viruses among optimists. Regression analyses showed that the relation between optimism and lower EBV titers was partially mediated by the lower depression levels experienced by optimists.

Dysfunctional Attitudes, Coping, and Depression Among HIV-Seropositive Men Who Have Sex with Men

Several studies have documented elevated levels of psychological distress among HIV-seropositive (HIV+) symptomatic men who have sex with men (MSM). However, very little is known about the role of dysfunctional attitudes and coping strategies in maintaining and ameliorating distress levels in ways that can inform those developing psychosocial interventions for HIV+ persons. This study evaluated relations between dysfunctional attitudes and depression and examined the role of coping as a mediator of this relationship among 115 HIV+ symptomatic MSM. Higher Dysfunctional Attitude Scale scores were associated with more reported depressive symptoms. The use of adaptive coping strategies such as active coping was associated with lower depression, whereas use of maladaptive strategies such as denial was related to higher levels of depression. Both adaptive and maladaptive coping strategies mediated the relationship between dysfunctional attitudes and depression. Findings suggest that interventions aiming at reducing psychological distress in this population using cognitive restructuring and related techniques may achieve their effects by enhancing adaptive coping strategies on the one hand and reducing maladaptive strategies on the other.

Attitudes Toward Direct-to-Consumer Advertisements and Online Genetic Testing Among High-Risk Women Participating in a Hereditary Cancer Clinic

Genetic testing for the breast cancer genes 1/2 (BRCA 1/2) has helped women determine their risk of developing breast and ovarian cancer. As interest in genetic testing has grown, companies have created strategies to disseminate information about testing, including direct-to-consumer advertising (DTCA) and online genetic testing. This study examined attitudes toward DTCA and online testing for BRCA among 84 women at a high-risk clinic as well as additional factors that may be associated with these attitudes, such as personal and familial cancer history, cancer worry and risk perception, and history with genetic testing/counseling. Results showed that the majority of the women held favorable attitudes toward DTCA for BRCA testing but did not support online testing. Factors such as familial ovarian cancer, cancer worry, and satisfaction with genetic counseling/testing were associated with positive attitudes toward DTCA, whereas personal breast cancer history was related to negative attitudes. The findings suggest that women may view DTCA as informational but rely on physicians for help in their decision to undergo testing, and also suggest that cancer history may affect womens acceptance of DTCA and genetic testing.