A Brief Gratitude Writing Intervention Decreased Stress and Negative Affect During the COVID-19 Pandemic.

Exploring ways to mitigate the stress of the COVID-19 pandemic is important for long-term health. Expressive and gratitude-focused writing are effective methods to help individuals process traumatic or stressful events. Gratitude-focused writing may yield additional benefits because it helps individuals appraise events positively. We hypothesized that an online gratitude writing intervention would yield greater benefits than an expressive writing intervention or control group. Participants were randomized to one of three groups and completed assessments one-week and one-month post-intervention. The gratitude writing group maintained gratitude levels and decreased stress and negative affect at one-month post-intervention. The expressive writing group decreased in gratitude and showed no changes in stress or negative affect at one-month post-intervention. The control group decreased in gratitude and negative affect and showed no changes in stress at one-month post-intervention. Gratitude writing may be a better resource for dealing with stress and negative affect than traditional expressive writing methods under extremely stressful situations with uncertain trajectories.

Internalized Weight Stigma, Psychological Well-Being, and Sleep in Women.

BACKGROUND: Many women internalize negative attitudes regarding body shape and size because of the societal standards for women's ideal body shapes and sizes. Internalized weight stigma is related to poorer physical and psychological health. A growing body of research has documented the links between other forms of internalized stigma (e.g., HIV-stigma) and poor sleep quality; however, little research examines the links between internalized weight stigma and sleep or the mechanisms that explain this relationship. Internalized weight stigma may be associated with poor sleep through increases in psychological distress. This study hypothesized that the links between internalized weight stigma and sleep would be mediated by higher levels of depression and anxiety. METHODS: About 257 women were recruited via social media, word of mouth, and an undergraduate participant pool. Participants completed an online survey assessing various aspects of weight stigma and health through self-report questionnaires. Most women were non-Hispanic White (86.8%) and had a mean age of 31.40. RESULTS: The indirect effects of internalized weight stigma on poorer global sleep quality and daily disturbances through depression and anxiety were significant. In contrast, depressive symptoms but not anxiety explained the links between internalized weight stigma and perceived sleep quality and neither depressive symptoms nor anxiety explained the link between internalized weight stigma and sleep efficiency. CONCLUSIONS: Internalized weight stigma is linked to poorer sleep quality, and these links may be explained by psychological well-being. Understanding the mechanisms by which internalized weight stigma is associated with sleep quality can inform the psychological interventions employed.

Self-Compassion in PLWH: Less Internalized Shame and Negative Psychosocial Outcomes.

People living with HIV (PLWH) may experience internalized shame, which has been associated with negative psychosocial outcomes. Some of these psychosocial outcomes also are linked with worsening disease. Self-compassion, however, is the antithesis of internalizing shame, with elements of self-compassion (self-kindness, mindfulness, common humanity) at odds with indicators of internalized shame (negative beliefs about the self, desire to withdraw or avoid emotion, feelings of isolation). Therefore, we examined whether self-compassion among PLWH was associated with lower levels of internalized shame and, in turn, better psychosocial outcomes. We examined these relations using cross-sectional data collected from 181 PLWH living in the US via their participation in an online survey. Results revealed initial support for lower levels of internalized shame as potential mechanism that may explain how self-compassion comes to be associated with better outcomes among PLWH. Given self-compassion can be induced through intervention, we discuss how future research and clinical work with PLWH might address shame and improve outcomes.

Weight-related shame and guilt, intuitive eating, and binge eating in female college students.

Shame and guilt are associated with greater eating disorder symptomatology, including binge eating. These emotional states may be related to binge eating as a result of one's attempt to use food as a means of coping. Little research has examined associations between weight-specific negative emotions and eating behaviors. Even less research has examined the role of intuitive eating as a mitigating factor of these associations. This study examined the relationships among weight-related shame and guilt and binge eating symptomatology in a sample of 196 undergraduate women. Further, we assessed the role of intuitive eating as a moderator of these relationships. Female college students completed an online questionnaire assessing demographics, weight-related shame and guilt, intuitive eating, and binge eating. After accounting for covariates, including body mass index, multiple regression analyses revealed that weight-related shame and guilt were related to increased binge eating symptomatology. Further, intuitive eating attenuated the relationship between weight-related shame and binge eating, but not between weight-related guilt and binge eating. Intuitive eating may be a protective factor for women experiencing weight-related shame.

Internalised HIV-stigma, loneliness, depressive symptoms and sleep quality in people living with HIV.

OBJECTIVE: People living with HIV (PLWH) commonly report sleep disturbances which are associated with long-term health consequences, including disease progression. PLWH also experience internalised stigma as a result of their HIV status, which can be associated with increased loneliness and depression. Little attention focuses on the impact of these factors on sleep. Therefore, we examined whether internalised HIV-stigma was indirectly related to poorer sleep quality through higher levels of loneliness and depressive symptoms. DESIGN: 181 PLWH from across the United States completed an online survey. Main Study Measures: Internalised HIV-stigma was assessed using the HIV-Stigma Scale, loneliness was assessed using the UCLA-Loneliness Scale-Short Form, depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Index, and Sleep Quality was assessed using the Pittsburgh Sleep Quality Index. RESULTS: Internalised HIV-stigma was indirectly associated with poorer global sleep quality and daytime sleep dysfunction through both loneliness and depressive symptoms. CONCLUSIONS: PLWH who experience HIV-related stigma may experience greater feelings of loneliness, which are related to increased depressive symptoms and poorer sleep quality. Interventions focused on improving sleep in PLWH should focus on multiple factors that influence sleep, including psychosocial factors such as stigma, social isolation and depressive symptoms.

Gender differences in disclosure concerns and HIV-related quality of life.

HIV-related disclosure concerns are associated with higher rates of concealment and poorer well-being, including poorer health related HIV quality of life (HIV-QOL). Little research, however, has examined whether gender differences exist in the links between HIV disclosure concerns and HIV-QOL. We expected that disclosure concerns and gender would be associated with HIV-QOL, such that the relationship between disclosure concerns and poorer HIV-QOL to be stronger in women living with HIV (WLWH) than in men living with HIV (MLWH). One hundred and forty MLWH (n = 102) and WLWH (n = 38) completed an online questionnaire consisting of measures regarding their demographics, disclosure concerns (HIV-stigma scale), and HIV-QOL (HIV-AIDS-Targeted Quality of Life Instrument). Results suggested that more disclosure concerns were associated with poorer HIV-QOL, but in general, men and women did not differ in their levels of HIV-QOL. As expected, interactions emerged between gender and disclosure concerns such that disclosure concerns were associated with increased health worries and poorer sexual functioning for WLWH but not for MLWH. Interventions should acknowledge the differing needs and experiences of WLWH in order to improve HIV-QOL and increase longevity.

Ethnic differences in the links between benefit finding and psychological adjustment in people living with HIV.

Experiencing growth after the diagnosis of a life threatening illness is commonly reported among people living with HIV (PLWH). The links between benefit finding and better adjustment in PLWH have been identified, but it is less clear whether these links vary by ethnicity. Minority stress theory suggests that individuals from minority populations may have unique stress experiences, which can have negative health implications but may also provide opportunity for growth. We hypothesized that the association between benefit finding and psychological adjustment would be stronger for Black (n = 80) than White (n = 87) PLWH. Contrary to predictions, the relationship between benefit finding and better adjustment was significant for White but not Black PLWH. Post-hoc analyses suggested that sexual orientation played role in this relationship. The relationship between benefit finding and psychological adjustment may be complex for Black PLWH, or they may achieve adjustment using other resources.

Oxytocin, social support, and sleep quality in low-income minority women living with HIV.

Sleep disturbances are highly prevalent in women with HIV, and few studies examine potential protective factors that may reduce risk for sleep disturbances in this high-risk population. This study predicted that HIV-specific social support from various sources (i.e., friends, family members, and spouses), as well as oxytocin (OT), would explain sleep quality in 71 low-income minority women living with HIV. Social support from family members was associated with better sleep quality in women. For women with high OT, support from friends was associated with better sleep quality, whereas for women with low OT, support from friends was associated with poorer sleep quality. Women with low OT may not effectively interpret and utilize available support resources, which may be associated with sleep disturbances.

Ethnicity moderates the relationship between perceived stress and benefit finding in HIV+ men who have sex with men (MSM).

BACKGROUND: Numerous studies conducted within the USA demonstrate higher levels of benefit finding in ethnic minority individuals compared to nonminority individuals living with chronic disease. PURPOSE: As benefit finding may be a salient buffer for the effects of stress, the current study examined the association between perceived stress and benefit finding in human immunodeficiency virus (HIV)+ men who have sex with men (MSM) living in the southeast USA and investigated whether ethnicity was a moderator of this relationship. We hypothesized that benefit finding would be greater in ethnic minority MSM than in white MSM and that ethnic minority MSM with high levels of stress would experience greater benefit finding than their white MSM counterparts. METHOD: The current study utilized baseline (T1) and 3-month follow-up (T2) data drawn from a previous trial of a psychosocial intervention in HIV+ MSM. Participants were 130 HIV+ MSM; 52 % were white and 48 % belonged to minority ethnic groups (African-American, Caribbean-American, Hispanic). RESULTS: Analyses revealed that benefit finding was greater in ethnic minority MSM at baseline; however, this difference became nonsignificant when age, education level, highly active antiretroviral therapy adherence, and CD4 count were added to the model. Moderated regression analyses revealed a significant interaction between T1 perceived stress and ethnicity in predicting T2 benefit finding, such that higher levels of T1 perceived stress predicted lower levels of T2 benefit finding in ethnic minority MSM only. This association was independent of intervention group assignment. CONCLUSION: The current study's results highlight potential differences in the relationship between stress and benefit finding processes in white and ethnic minority HIV+ MSM.

Self-reported sleep disturbance is associated with lower CD4 count and 24-h urinary dopamine levels in ethnic minority women living with HIV.

BACKGROUND: Sleep disturbance is associated with dopamine dysregulation, which can negatively impact immune status. Individuals living with HIV experience more sleep difficulties, and poor sleep may compound immune decrements associated with HIV infection. Little research has examined associations between sleep, dopamine, and immune status (CD4 count) in individuals with HIV. As ethnic minority women living with HIV (WLWH) are at heightened risk for HIV disease progression, we related sleep reports to both CD4 count and dopamine levels in a cohort of ethnic minority WLWH. METHODS: Participants were 139 low-income WLWH (ages 20-62; 78.3% African-American or Caribbean) who reported both overall sleep quality and sleep disturbance on the Pittsburgh sleep quality index (PSQI). CD4 count and HIV viral load were measured via morning peripheral venous blood samples, and concentrations of dopamine were measured via 24-h urine collection. Covariates included HIV viral load, length of time since HIV diagnosis, HAART adherence, perceived stress and depression. RESULTS: After controlling for all covariates, greater sleep disturbance was associated with significantly lower CD4 count (ß=-.20, p=.03) and lower levels of dopamine (ß=-.25, p=.04). Poorer overall sleep quality was marginally associated with lower CD4 count (ß=-.16, p=.08), and was not associated with dopamine. CONCLUSION: Our analyses suggest that sleep disturbance is independently related with immune status and dopamine levels in WLWH. Lower levels of dopamine may indicate neuroendocrine dysregulation and may impact immune and health status. Results highlight sleep disturbance rather than overall sleep quality as potentially salient to neuroendocrine and immune status in ethnic minority WLWH.

Ethnic identity and perceived stress in HIV+ minority women: the role of coping self-efficacy and social support.

BACKGROUND: Ethnic minority women living with HIV (WLWH) face multiple stigmas that can contribute to overwhelming levels of stress, which could hamper their ability to manage their chronic disease. Little is known about whether having a greater sense of ethnic identity might insulate WLWH from stress. It is also possible that certain cognitive and interpersonal factors (i.e., coping self-efficacy and perceived social support) may act as mediators of this relationship. We hypothesized that WLWH with a greater sense of ethnic identity would report less stress because they access these cognitive and interpersonal resources to better manage stressors. PURPOSE: The present study (1) related ethnic identity to perceived stress and (2) examined coping self-efficacy and social support as co-mediators of this relationship in a sample of low-income minority WLWH. METHOD: Ninety-two minority women (89% African American) completed self-report psychosocial measures including the Multigroup Ethnic Identity Measure (MEIM), Perceived Stress Scale (PSS), Cognitive Coping Self-efficacy Scale (CCSE), and Social Provision Scale (SPS). RESULTS: Greater ethnic identity was associated with less perceived stress, and this relationship was mediated by greater levels of both coping self-efficacy and social support. CONCLUSIONS: WLWH who identify more with their ethnic group may experience less stress via their access to more cognitive and interpersonal resources.

Stress buffering effects of oxytocin on HIV status in low-income ethnic minority women.

BACKGROUND: Elevated perceptions of psychosocial stress and stressful life events are linked to faster disease progression in individuals living with HIV and these associations may be stronger for women from ethnic minority populations. Levels of neurohormones such as oxytocin (OT), cortisol, and norepinephrine (NE) have been shown to influence the effects of psychosocial stress in different populations. Understanding how intrinsic neuroendocrine substances moderate the effects of stressors in minority women living with HIV (WLWH) may pave the way for interventions to improve disease management. METHODS: We examined circulating levels of plasma OT as a moderator of the effects of stress on disease status (viral load, CD4+ cell count) in 71 low-income ethnic minority WLWH. RESULTS: At low levels of OT, there was an inverse association between stress and CD4+ cell counts. Counter-intuitively, at high levels of OT there was a positive association between stress and CD4+ cell counts. This pattern was unrelated to women's viral load. Other neuroendocrine hormones known to down-regulate the immune system (cortisol, norepinephrine) did not mediate the effects of OT and stress on immune status. CONCLUSIONS: OT may have stress buffering effects on some immune parameters and possibly health status in low income ethnic minority WLWH reporting elevated stress.

Spousal support following knee surgery: roles of self-efficacy and perceived emotional responsiveness.

OBJECTIVE: The objective was to investigate self-efficacy to manage recovery from surgery and perceptions of the spouse's emotional responsiveness of adults recovering from knee surgery as mediators of the association between the quality of support from the spouse following surgery and recovery outcomes. RESEARCH METHOD: In-person interviews of married older adults (N = 134) with osteoarthritis of the knee who underwent total knee replacement surgery were conducted at 1 month before surgery, 1 month after surgery, and at 3 months after surgery. MAIN OUTCOME MEASURES: Outcomes were knee limitations and depressive symptoms. RESULTS: Self-efficacy mediated the associations between emotional support and problematic support and improvement in knee limitations as well as between emotional support and improvement in depressive symptoms. Perceptions of the spouse's emotional responsiveness did not mediate associations between support and recovery outcomes. CONCLUSIONS: Findings suggest that emotional support from the spouse can improve recovery outcomes in part by strengthening efficacy beliefs to manage recovery, and problematic support can hinder optimal recovery in part by weakening efficacy beliefs.

Men's serostatus disclosure to parents: associations among social support, ethnicity, and disease status in men living with HIV.

BACKGROUND: Directly disclosing a positive HIV serostatus to family members can affect psychological and disease status. Perceptions that one is in a supportive family environment may moderate these effects; however, ethnic differences may exist in the support processes of families coping with HIV. METHODS: We examined the role of serostatus disclosure to parents, HIV-specific family support, and ethnicity (Latino versus non-Hispanic White) in explaining disease status (HIV Viral Load, CD4+ cell count) in a sample of men living with HIV (MLWH). Men (n=120) reported whether they had disclosed their serostatus to their mothers and fathers, rated their perceptions of HIV-specific social support received from family members, and provided morning peripheral venous blood samples to assess immune function. We also collected psychosocial and urinary neuroendocrine indicators of stress/distress as possible mediator variables. RESULTS: A three-way interaction emerged between serostatus disclosure to mothers, HIV-specific family support, and ethnicity in explaining both viral load and CD4+ cell count. Non-Hispanic White men who had disclosed to mothers and were receiving high family support had a lower viral load and higher CD4+ cell count, but Latino men who had disclosed to mothers and were receiving low family support had a higher viral load. These associations were not accounted for by men's medication adherence, psychological distress, or neuroendocrine hormones. Disclosure to fathers was not related to disease status. CONCLUSIONS: The effects of serostatus disclosure on disease status may depend, in part, on ethnic differences in the interpersonal processes of men's close family relationships.

Disclosing HIV serostatus to family members: Effects on psychological and physiological health in minority women living with HIV.

BACKGROUND: Directly disclosing a positive HIV serostatus to family members can have psychological and physiological health benefits. Perceptions that one is in a supportive family environment may enhance these benefits. PURPOSE: We examined a mediated moderation model in which we expected interactions between serostatus disclosure to family members and HIV-specific family support to be associated with women's perceived stress, which in turn would explain depressive symptoms and 24-h urinary cortisol in women living with HIV (WLWH). METHOD: Low-income ethnic minority WLWH (n = 82) reported the percentage of family members they had directly disclosed their serostatus to, perceptions of HIV-related support from family members, perceived stress, and depressive symptoms. Cortisol was measured via 24-h urinary collection. RESULTS: Disclosure to spouses and children coupled with high levels of family support was associated with higher levels of depressive symptoms in women. For disclosure to spouses, this relationship was explained by higher perceived stress. Direct disclosure to mothers in tandem with high support was associated with lower cortisol, and this relationship was explained through higher levels of perceived stress. CONCLUSION: The effects of serostatus disclosure on perceived stress and health in WLWH may depend, in part, on women's family environment and to whom they disclose to within that environment.

Spouses' use of pressure and persuasion to promote osteoarthritis patients' medical adherence after orthopedic surgery.

OBJECTIVE: The authors investigated health-related effects of social control (influence) that spouses exert in relation to osteoarthritis patients' medical adherence after total knee replacement surgery. Patients' behavioral and emotional responses to control were examined as mediators of associations between spouses' use of two control strategies (pressure, persuasion) and patients' physical and psychological recovery. DESIGN: The authors used a three-wave panel design with assessments at one month before surgery, 1 month and 3 months after surgery. Data were collected during in-person interviews with 70 married, older adult patients. MAIN OUTCOME MEASURES: Recovery outcomes were assessed as improvement in knee limitations and depressive symptoms at the 3 month follow-up. RESULTS: Spousal pressure and persuasion at one month postsurgery were indirectly associated with patients' recovery outcomes through patients' positive emotional responses to control. CONCLUSION: Although there are often immediate behavioral benefits in response to partners' use of both pressure and persuasion, the long-term health effects of these strategies seem to be accounted for by their opposing links to positive emotions. Findings further refine theory on health-related social control in marriage.

Hostility, emotional expression, and hemodynamic responses to laboratory stressors: reactivity attenuating effects of a tendency to express emotion interpersonally.

The present study examined the interactive effects of hostility and a predisposition towards emotional expression or suppression in interpersonal situations. We also attempted to partially replicate findings from a recent investigation which provided evidence of lower myocardial and greater vascular responses in high-hostile relative to low-hostile individuals. Undergraduate students (n=99) participated in a protocol consisting of rest periods, speech preparation and presentation, a social-evaluative mental arithmetic task, and a stress interview. After classifying participants into high/low hostility by high/low interpersonal emotional expression groups using median-splits, high-hostile individuals showed lower HR and SBP responses to speech preparation and reported greater threat appraisal and negative affect than low-hostile participants. High-hostile interpersonal expressors and male interpersonal expressors displayed lower DBP and TPR reactivity, respectively, than high-hostile or male suppressors. High-hostile expressors also reported lower levels of positive affect than high-hostile suppressors, and expressors reported lower threat appraisals than suppressors, irrespective of hostility. Findings are discussed in terms of an absence of conflict or ambivalence over interpersonal emotional expression for high-hostile expressors and are suggestive of potential health benefits of expressing emotion interpersonally for at-risk groups.

Emotional support and affect: associations with health behaviors and active coping efforts in men living with HIV.

The present study represents a cross-sectional examination of the relationship between affect, social support and illness adjustment in men diagnosed with HIV/AIDS. Positive and negative affect were examined as separate mediators of the relationship between emotional support received from a primary support provider and illness adjustment in 105 men living with HIV. Results suggested that depressive symptoms emerged as a mediator between emotional support and engaging in healthy lifestyle behaviors (assessed by summary index). In contrast, positive affect emerged as the primary mediator between emotional support and greater amounts of active coping. Overall, findings suggested that emotional support from close others was indirectly associated with health behaviors and coping through recipients' affective states, and that these positive and negative affective states had differential relationships with multiple aspects of illness adjustment in men living with HIV.

Psychosocial and behavioral interventions for chronic medical conditions.

PURPOSE OF REVIEW: This paper critically reviews recent studies that have used behavioral or psychosocial interventions aimed at preventing type 2 diabetes mellitus, cardiovascular disease and HIV/AIDS as well as the psychosocial management of cardiovascular disease, HIV and cancer. RECENT FINDINGS: Behavioral (lifestyle) interventions can decrease risk of type 2 diabetes mellitus and cardiovascular disease. Psychosocial interventions have proven efficacy for alleviating distress in patients medically treated for cancer, cardiovascular disease and HIV/AIDS. These interventions may also help to prevent HIV infection, and improve medication adherence in HIV/AIDS. SUMMARY: Behavioral and psychosocial interventions are useful in preventing some chronic diseases and for alleviating distress in patients who have been medically treated for diseases such as cancer, cardiovascular disease and HIV/AIDS. Findings regarding the effects of psychosocial interventions on disease processes, morbidity and mortality are not yet well established and require appropriate clinical trials.

Effects of spousal control and support on older adults' recovery from knee surgery.

The authors investigated associations between spousal control (influence) and support on the recovery outcomes for 70 men and women (mean age = 70) undergoing an increasingly common surgical treatment for osteoarthritis (OA) of the knee. Spouses' positive (motivating) and negative (pressuring) control and spouses' emotional (understanding) and problematic (dismissing) support were examined as predictors of patients' adherence and improvement in well-being. Positive control was associated with better adherence, but only among patients whose spouses provided little problematic support. In contrast, negative control strategies tended to elicit increases in negative affect. Overall, our findings revealed that the effectiveness of spousal control depended largely on the quality of support provided by the spouse.