Background Stress Inventory: Developing a Measure of Understudied Stress.

Background stress is an understudied source of stress that involves both ambient stress and daily hassles upon which new stressors are superimposed. To date, an accurate measure of the background stress construct has not been available. We developed the Background Stress Inventory, a 25-item self-report measure that asks respondents to indicate how distressed they have felt over the past month and the majority of the past year across five domains: financial, occupation, environment, health and social. Seven hundred seventy-two participants completed the paper-and-pencil measure; the sample was randomly split into two separate subsamples for analyses. Exploratory factor analysis suggested five factors corresponding to these domains, and confirmatory factor analysis showed acceptable global fit (X(2)(255) = 456.47, comparative fit index = 0.94, root mean square error of approximation = 0.045). Cronbach's alpha (0.89) indicated good internal reliability. Construct validity analyses showed significant positive relationships with measures of perceived stressfulness (r = 0.62) and daily hassles (0.41), p's < 0.01. Depressive symptoms (0.62) and basal blood pressure (0.21) were both significantly associated with background stress, p's < 0.01. The importance of the proposed measure is reflected in the limited research base on the impact of background stress. Systematic investigation of this measure will provide insight into this understudied form of chronic stress and its potential influence on both psychological and physical endpoints.

Look on the bright side: do the benefits of optimism depend on the social nature of the stressor?

Growing evidence suggests that a number of personality traits associated with physical disease risk tend to be social in nature and selectively responsive to social as opposed to non-social stimuli. The current aim was to examine dispositional optimism within this framework. In Study 1, optimism was projected into the Interpersonal Circumplex and Five Factor Model revealing significant interpersonal representation characterized by high control and affiliation. Study 2 demonstrated that higher dispositional optimism attenuated cardiovascular responses to a social (speech) but not non-social stressor (cold pressor) task. Optimism-related attenuation of reactivity to the social vs. non-social stressor contributes further evidence to an emerging picture of psychosocial risk as largely reflecting person x social environment interactions.

Long-term effectiveness of a comprehensive pain management program: strengthening the case for interdisciplinary care.

Chronic pain, a debilitating medical condition affecting approximately 15% of the US population, leads to individual suffering and costs to society in terms of health care dollars and lost productivity. To examine the effectiveness of a comprehensive pain management program, data from 108 program participants were evaluated. Preprogram, postprogram, and 6-month follow-up data were collected from 80 participants, and preprogram, postprogram, and 1-year data were collected from 46 participants. Outcomes data from several domains were assessed: pain severity, emotional distress, interference of pain on function, perceived control of pain, treatment helpfulness, and number of hours resting. Within-subject repeated-measure analyses of variance found statistically significant findings on the six outcome measures utilized in this study for both the 6-month and 1-year samples. Examination of 95% confidence intervals revealed no overlap in pretreatment scores with 6-month and 1-year outcomes in five of the six domains studied. Mean scores on emotional distress did not maintain statistical significance in the 6-month or 1-year review. Overall, this study strengthens the case for interdisciplinary care for chronic pain management and provides evidence for the long-term effectiveness of this therapy. Furthermore, this study lends support to the notion that interdisciplinary treatments are effective in targeting multiple domains affected by the pain condition.

Uncertainty during the transition from cancer patient to survivor.

This prospective study evaluated the impact that uncertainty has on quality of life as cancer patients end the active phase of their treatment. The transition from patient status to survivor may be a particularly important point in recovery because it may affect how much stress cancer survivors experience. Guided by a within-subjects design framework, 53 cancer patients (predominantly breast cancer) participated in the present study as they approached the end of adjuvant treatment and were followed for 4 months. Distress levels increased the further patients moved away from the end-of-active treatment; however, preceding these ascending scores of distress was a period characterized by little unrest-best described as a "honeymoon" phase. Using hierarchical linear modeling, greater uncertainty 1 month after treatment ended predicted more functional and physical impairment 4 months after the completion of adjuvant treatment. In both cases, uncertainty accounted for nearly 70% of the variance of these changes over time. A period of rest may emerge as active treatment ends, but that it is short-lived, particularly if uncertainty regarding health emerges. Furthermore, uncertainty may a represent a key mechanism (and target for intervention) during the transition from cancer patient to survivor.

Impact of a breast cancer diagnosis on adult children's cognitive and emotional coherence.

The current study examined whether adult children of recently diagnosed breast cancer patients experience heightened general and major stressor-related distress, and identified a potential mediator between these two forms of distress. Unique from other stress studies, the current study proposed a novel intrapsychic construct, the extent to which one understands and recognizes his or her thoughts and feelings related to a major stressor, for which we coined the term cognitive and emotional coherence. Albeit preliminary, findings supported study hypotheses and argue that this construct may represent an important mediator of distress as well as a pivotal target for psychosocial intervention.

The role of mood states underlying sex differences in the perception and tolerance of pain.

While sex differences in pain reporting are frequently observed, the reasons underlying these differences remain unclear. The present study examined sex differences in self-report and physiological measures of pain threshold and tolerance following the administration of two laboratory pain-induction tasks. The primary study aim centered on determining whether repeated exposure to such tasks would yield sex differences in terms of pain threshold and tolerance. In addition, it was hypothesized that if such differences did exist, negative mood states might account for changes in pain ratings, threshold, and/or tolerance in subsequent exposure to noxious stimuli. Recruited from a convenience sample, 66 participants (44 female and 22 male) were exposed to both thermal and cold noxious stimuli at three separate times, while psychophysiological and self-report data were collected. Because women outnumbered men 2:1, Fisher z transformations were performed to determine whether the observed associations between mood states and pain ratings differed. We found stronger associations between fatigue and thermal-heat pain ratings for men at their first and third exposure to the pain task compared to women (z = 2.11, P < 0.05; z = 3.14, P < 0.001, respectively). Results indicated that women evidenced greater pain tolerance than men on both a behavioral and physiological level; however, they reported greater pain severity than men. Fatigue was also found to be particularly important to reports of pain severity in men and pain tolerance in response to noxious stimuli for women. Possible pathways in which mood states influenced these endpoints are discussed.

Stress and quality of life in African American cancer survivors.

The quality of life (QOL) of cancer survivors must be investigated as we learn about the risks and protective factors associated with cancer survival. Little research has included African American cancer survivors, and this group could be more or less vulnerable to the added stress of cancer. By virtue of the greater stress burden imposed by minority status, lower socioeconomic status, and other social/ cultural factors, African Americans may be at increased risk for poor QOL and poor health outcomes. Alternatively, they may be protected from some of these negative outcomes. We propose a model to better understand the unique sociocultural features that influence QOL for certain cancer sites where racial disparities are well established. A comprehensive knowledge of QOL among these survivors will guide future research and facilitate the development of interventions to improve QOL, possibly reducing observed health disparities.

Expressive writing intervention for adolescents' somatic symptoms and mood.

The effects of a widely used expressive writing intervention on adolescents' somatic symptoms, distress, and positive psychological functioning were evaluated. Eighth-grade (n=106) students were randomly assigned to write about either an emotional or a neutral topic for 3 consecutive days. Students completed measures of somatic symptoms, medical visits, distress, and positive functioning at baseline, postintervention, and 2 and 6 weeks later. Somatic symptoms and medical visits were unchanged as a result of the intervention. However, significant Time Condition effects indicated that optimism scores increased, negative-affect scores decreased, and positive-affect words in student essays increased in the experimental condition. Expressive writing shows promise as a cost-efficient intervention to address the emotional concerns of young adolescents; further work with clinical populations may lead to even more robust results.