Abstract
The relations among cognitive processing of stressful emotional material, mood, and immune functioning were examined in 30 asymptomatic gay men during the stress of HIV-1 seropositivity notification. We administered the Impact of Event Scale, and immunological and mood data were collected 5 weeks before, 1 week after, and 5 weeks after notification of HIV-1 seropositivity. Consistent elevations of avoidance or intrusion levels during the study period did not predict distress at 5 weeks postdiagnosis; rather, increased levels of both avoidance and intrusion over the study period were related to significantly greater anxiety, depression, and total mood disturbance by the end of the study. Increased intrusion, but not avoidance, during the period from study entry to 1-week postdiagnosis was related to higher levels of distress 1 week after HIV serostatus notification. In contrast, in the weeks following serostatus notification, increased avoidance predicted worse mood outcomes. Increased avoidance over the 10-week study period significantly predicted poorer proliferative response to pokeweed mitogen as well as trends toward lower T-helper-inducer lymphocyte (CD4+) percentages. Increased intrusion over this time period significantly predicted lower CD4+ percentages, controlling statistically for baselines. Mood change during the 10-week study did not mediate effects of cognitive processing on immune function. Mood changes may work jointly with cognitive processing to influence some immune outcomes. As increases in avoidant and intrusion processing may reflect difficulties in working through the trauma of HIV seropositivity notification, the current findings suggest the importance of thorough cognitive processing of traumatic medical information in this population for subsequent adjustment and immune functioning.
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REFERENCES
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.
Antoni, M. H. (1991). Psychosocial stressors and behavioral interventions in gay men with HIV infection. International Review of Psychiatry, 3, 385–402.
Antoni, M. H., Baggett, L., Ironson, G., LaPerriere, A., August, S., Klimas, N., Schneiderman, N., & Fletcher, M. (1991). Cognitive-behavioral stress management intervention buffers distress responses and immunologic changes following notification of HIV-1 seropositivity. Journal of Consulting and Clinical Psychology, 59, 906–915.
Antoni, M. H., Schneiderman, N., Klimas, N., LaPerriere, A., Ironson, G., & Fletcher, M. (1991). Disparities in psychological, neuroendocrine, and immunologic patterns in asymptomatic HIV-1 seropositive and seronegative gay men. Biological Psychiatry, 29, 1023–1041.
Baron, G. C., Klimas, N. G., Fischl, M. A., & Fletcher, M. A. (1985). Decreased natural cell-mediated cytotoxicity per effector cell in acquired immunodeficiency syndrome. Diagnostic Immunology, 3, 197–204.
Baron, R. M., & Kenney, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.
Baum, A. (1990). Stress, intrusive imagery and chronic distress. Health Psychology, 9, 653–675.
Beck, A., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
Beck, A., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized anxiety disorder: A predominance of thought activity. Behaviour Research and Therapy, 28, 153–158.
Creamer, M., Burgess, P., & Pattison, P. (1992). Reaction to trauma: A cognitive processing model. Journal of Abnormal Psychology, 101, 452–459.
Davidson, L. M., & Baum, A. (1986). Chronic stress and posttraumatic stress disorders. Journal of Consulting and Clinical Psychology, 54, 303–308.
DeMartini, R. M., Turner, R. R., Formenti, S. C., Boone, D. C., Bishop, P. C., Levine, A. M., & Parker, J. W. (1988). Peripheral blood mononuclear cell-abnormalities and their relationship to clinical course in homosexual men with HIV infection. Clinical Immunology and Immunopathology, 46, 258–271.
Derogatis, L. R., & Spencer, P. M. (1982). The Brief Symptom Inventory: Administration, scoring and procedures manual. Baltimore: Clinical Psychometrics Research.
Epping-Jordan, J. E., Compas, B., & Howell, D. C. (1994). Predictors of cancer progression in young adult men and women: Avoidance, intrusive thoughts, and psychological symptoms. Health Psychology, 13, 539–547.
Fletcher, M. A., Baron, G., Ashman, M., Fischl, M., & Klimas, N. (1987). Use of whole blood methods in assessment of immune parameters in immunodeficiency states. Diagnostic Clinical Immunology, 5, 69–81.
Giorgi, J., & Detels, R. (1989). T-cell subset alterations in HIV-infected homosexual men: NIAID Multicenter AIDS Cohort Study. Clinical Immunology and Immunopathology, 52, 10–18.
Glaser, R., & Kiecolt-Glaser, J. (1987). Stress-associated depression in cellular immunity: Implications for acquired immune deficiency syndrome (AIDS). Brain, Behavior and Immunity, 1, 107–112.
Goodkin, K. (1988). Psychiatric aspects of HIV infection. Texas Medicine, 84, 55–61.
Herberman, R., & Holden, H. (1978). Natural cell-mediated immunity. Advances in Cancer Research, 27, 305–377.
Herbert, T. B., & Cohen, S. (1993a). Depression and immunity: A meta-analytic review. Psychological Bulletin, 113, 472–486.
Herbert, T. B., & Cohen S. (1993b). Stress and immunity in humans: A meta-analytic review. Psychosomatic Medicine, 55, 364–379.
Horowitz, M. J. (1982). Stress response syndromes and their treatment. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects (pp. 711–732). New York: The Free Press.
Horowitz, M. (1986). Stress response syndromes (2nd ed). New York: Jacob Aronson.
Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale. Psychosomatic Medicine, 41, 209–218.
Ironson, G., Friedman, A., Klimas, N., Antoni, M., Fletcher, M. A., LaPerriere, A., Simoneau, J., & Schneiderman, N. (1994). Distress, denial, and low adherence to behavioral interventions predict faster disease progression in gay men infected with human immunodeficiency virus. International Journal of Behavioral Medicine, 1, 90–105.
Ironson, G., LaPerriere, A., Antoni, M. H., O'Hearn, P., Schneiderman, N., Klimas, N., & Fletcher, M. A. (1990). Changes in immune and psychological measures as a function of anticipation and reaction to news of HIV-1 antibody status. Psychosomatic Medicine, 52, 247–270.
Jacobsen, P. B., Perry, S. W., & Hirsch, D. A. (1990). Behavioral and psychological responses to HIV antibody testing. Journal of Consulting and Clinical Psychology, 58, 31–37.
Jacobsen, P. B., Perry, S. W., Hirsch, D. A., Scavuzzo, D., & Roberts, R. B. (1988). Psychological reactions of individuals at risk for AIDS during an experimental drug trial. Psychosomatics, 29, 182–187.
Kaisch, K., & Anton-Cluver, H. (1989). Psychological and social consequences of HIV exposure: Homosexuals in Southern California. Psychology and Health, 3, 63–75.
Katoff, L., Dunne, R. (1988). Supporting people with AIDS: The gay men's health collective model. Journal of Palliative Care, 4, 88–95.
Kiecolt-Glaser, J., & Glaser, R. (1988). Methodological issues in behavioral immunology research with humans. Brain Behavior and Immunity, 2, 67–78.
Kizer, K., Green, M., & Perkins, C. (1988). AIDS and suicide in California [Letter]. Journal of the American Medical Association, 260, 1981.
Knapp, P., Levy, E. M., Giorgi, R., Black, P., Fox, B. H., & Heeren, T. C. (1992). Short-term immunologic effects of induced emotion. Psychosomatic Medicine, 54, 133–148.
Lane, C., & Fauci, A. S. (1985). Immunologic abnormalities in the acquired immunodeficiency syndrome. Annual Review of Immunology, 3, 477–500.
LaPerriere, A., Antoni, M. A., Schneiderman, N., Ironson, G., Klimas, N. G., Caralis, P., & Fletcher, M. A., (1990). Exercise intervention attenuates emotional distress and natural killer cell decrements following notification of positive serologic status for HIV-1. Biofeedback and Self-Regulation, 15, 229–242.
Lutgendorf, S. K., Antoni, M. H., Kumar, M., & Schneiderman, N. (1994). Changes in coping strategies predict EBV antibody titers following a stressor disclosure induction. Journal of Psychosomatic Research, 38, 63–78.
Lysle, D. T., Cunnick, J. E., Kucinski, B. J., Fowler, H., & Rabin, B. (1990). Characterization of immune alterations produced by a conditioned aversive stimulus. Psychobiology, 18, 200–226.
Maier, S., Watkins, L., & Fleshner, M. (1994). Psychoneuroimmunology: The interface between behavior, brain, and immunity. American Psychologist, 49, 1004–1017.
Mansour, I., Doinel, C., & Rouger, P. (1990). CD16+ NK cells decrease in all stages of HIV infection through a selective depletion of the CD16+CD8+CD3-subset. AIDS Research and Human Retroviruses, 6, 1451–1457.
Marzuk, P. M., Tierney, H., Tardiff, K., Gross, E. M., Morgan, E. B., Hsu, M. A., & Mann, J. J. (1988). Increased risk of suicide in persons with AIDS. Journal of the American Medical Association, 259, 1333–1337.
McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). EITS manual for the Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.
Nerenz, D. R., & Leventhal, H. (1983). Self-regulation theory in chronic illness. In T. G. Burish & L. A. Bradley (Eds.), Coping with chronic disease (pp. 13–81). New York: Academic Press.
Ostrow, D. G., Monjan, A., Joseph, J., Van Raden, M., Fox, R., Kingsley, L., Dudley, J., & Phair, J. (1989). HIV-related symptoms and psychosocial functioning in a cohort of homosexual men. American Journal of Psychiatry, 146, 737–742.
Pantaleo, G., Graziosi, C., & Fauci, A. S. (1993). The immunopathogenesis of human immunodeficiency virus infection. The New England Journal of Medicine, 328, 327–335.
Pennebaker, J. W. (1985). Traumatic experience and psychosomatic disease: Exploring the roles of behavioral inhibition, obsession, and confiding. Canadian Psychology, 26, 82–95.
Pennebaker, J. W., & Chew, C. H. (1985). Behavioral inhibition and electrodermal activity during deception. Journal of Personality and Social Psychology, 49, 1427–1433.
Polk, B. F., Fox, R., Brookmeyer, R., Kanchanaraska, S., Kaslow, R., Bisscher, B., Rinaldo, C., & Phair, J. (1987). Predictors of the acquired immunodeficiency syndrome developing in a cohort of seropositive homosexual men. The New England Journal of Medicine, 316, 61–66.
Redfield, R., & Burke, D. (1988). HIV infection: The clinical picture. Scientific American, 259, 90–98.
Reed, G., Kemeny, M., Taylor, S., Wang, H., & Visscher, B. (1994). Realistic acceptance as a predictor of decreased survival time in gay men with AIDS. Health Psychology, 13, 299–307.
Rundell, J., Paolucci, S., & Beatty, D. (1988). Psychiatric illness at all stages of human immunodeficiency virus infection [Letter]. American Journal of Psychiatry, 145, 652–653.
Stavosky, J. M., & Borkovec, T. D. (1987). The phenomenon of worry: Theory, research, treatment and its implications for women [Special Issue: Treating women's fear of failure]. Women and Therapy, 6, 77–95.
Stone, A., Cox, D. S., Valdimarsdottir, H., Jandorf, L., & Neale, J. M. (1987). Evidence that secretory IgA antibody is associated with daily mood. Journal of Personality and Social Psychology, 52, 988–993.
Suls, J., & Fletcher, B. (1985). The relative efficacy of avoidant and nonavoidant coping strategies: A meta-analysis. Health Psychology, 4, 249–288.
Trinchieri, G. (1989). Biology of natural killer cells. Advances in Immunology, 47, 187.
Workman, E. A., & La Via, M. F. (1987). T-lymphocyte polyclonal proliferation: Effects of stress and stress response style on medical students taking national board examinations. Clinical Immunology and Immunopathology, 43, 308–313.
Zilberg, N. J., Weiss, D. S., & Horowitz, M. J. (1982). Impact of Event Scale: A cross-validation study and some empirical evidence supporting a conceptual model of stress response syndromes. Journal of Consulting and Clinical Psychology, 50, 407–414.
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Lutgendorf, S.K., Antoni, M.H., Ironson, G. et al. Cognitive Processing Style, Mood, and Immune Function Following HIV Seropositivity Notification. Cognitive Therapy and Research 21, 157–184 (1997). https://doi.org/10.1023/A:1021880612642
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DOI: https://doi.org/10.1023/A:1021880612642