Coping strategies and integrative meaning as moderators of chronic illness.

This study contrasted the moderating effects of deriving integrative meaning (a primary appraisal process) with the use of specific, cognitive-behavioral strategies (a secondary appraisal process) in confronting stressors involving harm or loss. Eighty young adults and eighty older participants with varying levels of chronic illness were assessed. Open-ended responses to recalled experiences with illness and death were coded for integrative meaning and use of specific cognitive-behavioral strategies. In young adults with higher levels of chronic illness, a greater tendency to use specific cognitive-behavioral strategies was related to higher morale. In older participants, a greater tendency to derive integrative meaning was related to increased morale, regardless of illness levels.

Implicit power motivation moderates men's testosterone responses to imagined and real dominance success.

This study tested the hypothesis that implicit power motivation moderates individuals' testosterone responses to the anticipated success in and actual outcome of a dominance contest. Salivary testosterone levels were assessed in 42 male students at the beginning of the study, after they had imagined a success in an ensuing power contest, and immediately after the contest had taken place. Contest outcome (winning or losing against a competitor on a speed-based task) was varied experimentally. Participants' power motive was assessed with a picture-story exercise, in which an assertive, personalized (p Power) component was distinguished from an altruistic, socialized (s Power) component. In contrast to all other participants, individuals high only in p Power (a) had elevated testosterone after imagining a success in a subsequent dominance contest and (b) continued to have high testosterone levels after actually winning, but not after losing, the contest.

The effect of implicit and explicit motivation on recall among old and young adults.

Seventy-six elderly subjects aged sixty-five to eighty-seven and seventy-seven young adults aged twenty-five to forty were compared on implicit and explicit motive levels and on recall of introductions and working memory. Significantly fewer of the elderly than the young participants scored high in the implicit motives, n Affiliation and n Power, confirming results from U.S. national surveys. The surveys also demonstrated a significant decline with age in high levels of n Achievement, a decline not found here. The elderly participants showed major recall deficits on both tasks, but all three of the implicit motives studied were shown to enhance recall for the elderly, but not for the young adults. Eight elderly women scoring high on at least two of the three motives showed no recall deficits compared to the young women on two memory tasks. In old age implicit motive deficits contribute to poor memory but explicit commitments to have a good memory had no effect on recall.

Treatment of somatization in primary care.

A large proportion of patients present to primary care with chronic, stress-related symptoms having no organic cause. Biomedical treatment of these patients is usually ineffective and expensive. A 6-week behavioral medicine intervention designed to provide adjunctive treatment to primary care was evaluated in a randomized, controlled study. Thirty-eight individuals receiving treatment and 44 waiting for treatment completed the SCL-90-R at times corresponding to 1 week before (time 1) and 1 week after the course (time 2). The treatment group was then followed up at 6 months. After correction for initial levels, the treatment group reported significantly less somatization, anxiety, and depression than did the wait-list group at time 2. Within the treatment group, decreases in somatization, anxiety, and depression were statistically significant and were maintained 6 months later. Within the wait-list group, distress remained unchanged. A review of relevant literature reveals that a general behavioral medicine course such as the one studied here has an important adjunctive role in primary care, since 1) subsyndromal psychological distress is common in primary care; 2) physicians are reluctant to address psychosocial issues; 3) negative mood is associated with poor health; 4) negative mood is associated with high, inappropriate medical utilization; and 5) negative mood is associated with help-seeking behavior.

Lives of women and men active in the social protests of the 1960s: a longitudinal study.

This study found that 46 of 116 children from the R. R. Sears, E. E. Maccoby, and H. Levin (1957) child-rearing study classified at age 31 as participants in the protest movements of the 1960s came more often from middle-class families and attained higher educational levels than their counterparts who did not participate in the protests. In midlife, activists remained more rebellious and altruistic than their peers of equivalent education. Sixties activists did better in grade school and had positive permissive parents at age 5. Parenting style was associated with doing well in school only in girls. As adults, female activists were less involved in family life and had better jobs than their peers. Male activists did less well occupationally and were less happy than their male peers or the female activists.

Alexithymic characteristics and metabolic control in diabetic and healthy adults.

Diabetes has long been identified as a disease with possible psychological components. Alexithymia--an inability to express emotions verbally, operational thinking, and a lack of fantasy life--is found in a high proportion of psychosomatic patients. We therefore tested the hypothesis that diabetics would be more alexithymic than controls. In addition, the lack of awareness of affect was hypothesized to have negative consequences for the management of diabetes, as reflected in metabolic glucose control (HbA1). The number of emotion words produced in six imaginative (Thematic Apperception Test) stories was used as the measure of alexithymia, with few words reflecting alexithymic characteristics. Diabetics were found to be significantly more alexithymic than controls. Further, fewer emotion words (alexithymia) was associated with poorer metabolic control. These data suggest that alexithymic characteristics may interfere with a diabetic's ability to manage their illness, and support previous research showing that the suppression of emotions can lead to a difficulty in regulating glucose levels.

The role of affiliative loss in the recruitment of helper cells among insulin-dependent diabetics.

The study was undertaken to determine whether affiliative loss might play a role in the development of insulin-dependent diabetes by increasing the percentage of helper-inducer T cells when diabetics were reminded of the loss. It was found that diabetics who had experienced the recent death of a loved one showed a marked increase in helper cells, in contrast to diabetics who had not experienced a recent death, after both groups viewed a film about a happy, but doomed, love affair. The diabetics who had experienced a recent death also showed more affiliative distress after viewing the film. This increase in distress was associated with a physiological sign of increased activation, namely, increased plasma cortisol output, which in turn was associated with gains in helper-cell percentages. This suggests that frequent reminders of severe affiliative disturbances during the pre-onset histories of such diabetics may result in physiological activation, which leads to periodical recruitment of helper cells, which could augment the immune attack on the insulin-producing cells in the pancreas. None of these results was obtained with controls, which suggests that the diabetics were unusually sensitive to affiliative distress.

Motivational syndromes associated with natural killer cell activity.

This article reports three studies that taken together support two hypotheses: (a) that the stressed power motivation syndrome is associated with relatively low natural killer cell activity (NKCA) and (b) that the unstressed affiliation motivation syndrome is associated with higher NKCA. In Study 1, college students who were relatively high in stressed power motivation had significantly lower NKCA than did their peers. In addition, students high in unstressed affiliation motivation had significantly greater NKCA than did those showing less evidence of this syndrome. Study 2 replicated these findings on a sample of middle-class men. In Study 3, which tested the hypotheses among adult patients from a Health Maintenance Organization, results were in the same direction but less significant. Meta-analyses clearly indicate that the combined evidence from the three studies reliably supports both hypotheses.

A study of the effectiveness of two group behavioral medicine interventions for patients with psychosomatic complaints.

This randomized, prospective study investigated the effectiveness of two group behavioral medicine interventions for primary care patients experiencing physical symptoms with a psychosocial component (eg, palpitations, gastrointestinal disturbances, headaches, malaise, sleep disorders). The subjects were 80 volunteers at a health maintenance organization (HMO) in the greater Boston area. Both interventions focused on the mind/body relationship and used didactic material, relaxation-response training, awareness training, and cognitive restructuring. The two behavioral medicine intervention groups were compared with a group that focused exclusively on information about stress management and its relation to illness. Measures of visits to the HMO and of distress from physical and psychological symptoms were obtained before the interventions and again 6 months afterward. At the 6-month follow-up, patients in the behavioral medicine groups showed significantly greater reductions in visits to the HMO and in discomfort from physical and psychological symptoms than did the patients in the information group. The results suggest that when the relationship among thoughts and behaviors and symptoms of patients with psychosomatic dysfunction is actively addressed, the patients' discomfort level and the cost of medical care can be reduced.

Motivational factors in health and disease.

Evidence is reviewed that measures of motive strength, as measured through content analysis of associative thought, are related to physiological systems, the functioning of which affect health outcomes. Studies show that affiliative and power motive syndromes assessed in associative thought are associated with health and illness. A relaxed or easygoing affiliative motive syndrome characterizes insulin dependent Type I diabetics and can, if aroused, lead to poorer blood sugar control in such diabetics. A stressed power motive syndrome is associated with sympathetic activation, release of stress hormones, depressed immune functions, and greater susceptibility to infectious diseases. Affiliative trust and a greater sense of agency as measured in associative thought content are associated with better health. An intervention study and a longitudinal study have demonstrated that differences in the levels of these motivational variables are not simply the result of illness but lead to alterations in subsequent health status.

Secretory IgA as a measure of resistance to infectious disease: comments on Stone, Cox, Valdimarsdottir, and Neale.

We examined recent assertions of Stone, Cox, Valdimarsdottir, and Neale regarding the use of S-IgA concentrations in whole saliva as a measure of mucosal immune competence. Our conclusions are markedly different from theirs. In this article, we report the results of a meta-analysis that reveals a significant relation between psychosocial variables and salivary S-IgA concentrations. Second, we note that an inverse relation between salivary flow and S-IgA would not preclude studying salivary S-IgA concentration. Third, we present a different perspective on the assertion of Stone et al that IgA proteases in whole saliva potentially lead to erroneous results from the radial immunodiffusion assay. Fourth, we report a meta-analysis suggesting a statistically significant relation between S-IgA salivary concentrations and the incidence of acute upper respiratory illnesses. We conclude that there is no empirical or logical reason to prefer the measurement of another aspect of immunity to total S-IgA concentration in whole saliva.

The effect of an academic examination on salivary norepinephrine and immunoglobulin levels.

Forty-six college students provided saliva samples just after taking an examination, one hour and 45 minutes later, and several days later, at a period of rest. As compared with baseline levels, the power stress of an examination was associated with an increase in salivary immunoglobulin A (S-IgA), a measure of B-cell immune function, and with an increase in norepinephrine (NE) concentrations in the saliva. The increase in NE was greater for those for whom n power was greater than n affiliation rather than for those for whom the reverse was true. Greater increases in, and levels of, NE at the examination and after were associated with greater subsequent drops in S-IgA, which reached below baseline levels for those for whom n power was stronger. The examination stimulated adrenergic activity, which in the long run depressed immune function for those with a strong power motive who had been most aroused adrenergically by the examination.

Academic stress, power motivation, and decrease in secretion rate of salivary secretory immunoglobulin A.

The effect of academic stress on immune function, as measured by the rate of secretion of salivary secretory immunoglobulin A (s-IgA), was studied prospectively in 64 first-year dental school students. Perceived stress and s-IgA secretion rate were measured five times--during an initial low-stress period, three high-stress periods coinciding with major examinations, and a final low-stress period. The s-IgA secretion rate was significantly lower in high-stress than low-stress periods for the whole group. In addition, personality characteristics differentiated patterns of s-IgA secretion rates. Students characterised by a great need to establish and maintain warm personal relationships secreted more s-IgA at each point than did all other subjects. The s-IgA secretion rates of those with a high inhibited need for power continued to decline through the final low-stress period rather than recovering as in all other subjects.

Power motivation, stress and physical illness.

College students reporting a large number of life change events in the past six months also reported significantly more frequent and more severe instances of physical illness and more affective symptoms in the same time period. These relationships, however, were modified in an interesting way by type of life change and by individual differences. Life change events were classified as involving power, affiliative or other stresses. Individuals scoring high in the need for Power (n Power), in inhibition, and in the number of power stresses (HHH subjects), reported more severe physical illness and affective symptoms than all other subjects or, in particular, subjects low in n Power, power stress and inhibition (LLL subjects). Individuals scoring high in Power and high in either inhibition or power stress also reported significantly more severe physical illness than other subjects. Among subjects high in inhibition, affiliative stress in combination with high n Power was associated with more severe physical illness, but, among subjects low in inhibition, affiliative stress in combination with high n Affiliation was associated with more physical illness. Affiliative stress was unrelated to affective symptoms. Other stress was unrelated either alone or in combination with other variable to physical illness or affective symptoms. The findings are interpreted as consistent with the hypothesis that subjects in the HHH category compared with other subjects are characterized by chronically high sympathetic activity which has immunosuppressive effects, making them more illness prone.

Effects of personality and semantic content of stimuli on augmenting and reducing in the event-related potential.

Two groups of subjects classified as high vs. low in the need for power (n power) were assessed for augmenting versus reducing in the event-related potential (ERP) elicited by neutral and power-related words. Words at four different intensity levels in each of these two classes were randomly presented and ERPs in response to each word class at each of the four intensity levels were computed from EEG recorded at Fz. The results indicated that the two groups responded differentially to the power-related vs. neutral words. HIgh n power subjects showed reduction in response to both power-related and neutral words while low n power subjects showed augmentation in response to the power-related words.

The need for power, brain norepinephrine turnover and learning.

This experiment was designed to explore whether brain norepinephrine (NE) serves as a specific reward system for the power drive. Previous research has indicated that 3-methoxy-4-hydroxyphenyl glycol (MHPG), a urinary metabolite reflecting central NE turnover, is positively correlated with features of assertiveness which one might expect of a person high in the need for power (n power) or in a state of aroused power motivation. Twenty-seven male undergraduates, 13 of whom were high and 14 of whom were low in n power as assessed by a TAT measure, were recruited as subjects. Before and after the laboratory session, subjects voided all urine and concentrations of epinephrine, norepinephrine and MHPG were obtained from samples. The laboratory task consisted of 20 picture-word pairs in which the subject had to learn to anticipate the word associated with each picture before the word was presented. Five pairs of stimuli in each of the following picture-word combinations were presented 12 times: neutral-neutral, neutral-power, power-neutral and power-power. The results revealed that, as predicted, subjects high in n power learn most power-related material faster than subjects low in n power. The need for achievement is unrelated to the learning of any picture-word pairs. The neurochemical data indicated that subjects maintaining a relatively high MHPG excretion rate during the experiment who were also high in n power showed the greatest mastery of power related compared with neutral picture-word pairs. These findings are consistent with the hypothesis that brain NE turnover is specifically related to the learning of power-related responses in subjects high in n power.

Stressed power motivation, sympathetic activation, immune function, and illness.

Previous research has reported that individuals high in the need for Power, high in inhibition, and high in power stress (the HHH group) are more likely than other individuals to report more severe illnesses. The present study investigates the possibility that the mechanism underlying this relationship is greater sympathetic activation in the HHH group which has an immunosuppressive effect. College males with the HHH syndrome reported more frequent and more severe illnesses than other individuals, as in previous studies. More of the HHH than other subjects also showed above average epinephrine excretion rates in urine and below average concentrations of immunoglobulin A in saliva (S-IgA). Furthermore, higher rates of epinephrine excretion were significantly associated with lower S-IgA concentrations, and lower S-IgA concentrations were significantly associated with reports of more frequent illnesses. The findings are interpreted as consistent with the hypothesis that a strong need for Power, if it is inhibited and stressed, leads to chronic sympathetic overactivity which has an immunosuppressive effect making individuals characterized by this syndrome more susceptible to illness.