Cognitive-behavioral stress management intervention effects on anxiety, 24-hr urinary norepinephrine output, and T-cytotoxic/suppressor cells over time among symptomatic HIV-infected gay men.

The present study tested the effects of a multimodal cognitive-behavioral stress management (CBSM) intervention on anxious mood, perceived stress, 24-hr urinary catecholamine levels, and changes in T-lymphocyte subpopulations over time in symptomatic HIV+ gay men. Seventy-three men were randomized to either a group-based CBSM intervention (n = 47) or a wait-list control (WLC) condition (n = 26). Men assigned to CBSM showed significantly lower posttreatment levels of self-reported anxiety, anger, total mood disturbance, and perceived stress and less norepinephrine (NE) output as compared with men in the WLC group. At the individual level, anxiety decreases paralleled NE reductions. Significantly greater numbers of T-cytotoxic/suppressor (CD3+CD8+) lymphocytes were found 6 to 12 months later in those assigned to CBSM. Moreover, greater decreases in NE output and a greater frequency of relaxation home practice during the 10-week CBSM intervention period predicted higher CD3+CD8+ cell counts at follow-up.

[1]  E. Blanchard,et al.  Biochemical changes associated with thermal biofeedback treatment of hypertension , 1988, Biofeedback and self-regulation.

[2]  B. McEwen,et al.  Stress and the individual. Mechanisms leading to disease. , 1993, Archives of internal medicine.

[3]  Michel Hersen,et al.  Comprehensive clinical psychology , 1998 .

[4]  M. Fischl,et al.  Use of whole blood methods in assessment of immune parameters in immunodeficiency states. , 1987, Diagnostic and clinical immunology.

[5]  M. Ziegler,et al.  Norepinephrine elevations in cerebrospinal fluid after d- and l-amphetamine. , 1979, European journal of pharmacology.

[6]  Andrew P. Smith,et al.  Psychological stress and susceptibility to the common cold. , 1991, The New England journal of medicine.

[7]  M. Ziegler,et al.  The Catecholamines in psychiatric and neurologic disorders , 1985 .

[8]  N. Schneiderman,et al.  Psychosocial modulation of antibody to Epstein‐Barr viral capsid antigen and human herpesvirus type‐6 in HIV‐1‐infected and at‐risk gay men. , 1992, Psychosomatic medicine.

[9]  N. Schneiderman,et al.  Behavioral medicine : the biopsychosocial approach , 1985 .

[10]  J. Beary,et al.  The Relaxation Response †. , 1974, Psychiatry.

[11]  J. Kiecolt-Glaser,et al.  Stress-associated depression in cellular immunity: Implications for acquired immune deficiency syndrome (AIDS) , 1987, Brain, Behavior, and Immunity.

[12]  F. Richardson,et al.  Emotional skills training: A treatment program for duodenal ulcer , 1980 .

[13]  J. Marks.  Endocrine manifestations of human immunodeficiency virus (HIV) infection. , 1991, The American journal of the medical sciences.

[14]  John W. Ward,et al.  1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. , 1993, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[15]  J. Kiecolt-Glaser,et al.  Psychoneuroimmunology and health consequences: data and shared mechanisms. , 1995, Psychosomatic medicine.

[16]  T. Creer,et al.  Self-management of chronic disease : handbook of clinical interventions and research , 1986 .

[17]  J. Axelrod,et al.  Stress hormones: their interaction and regulation. , 1984, Science.

[18]  F. Fawzy,et al.  Coping with AIDS: Psychological and Health Implications1 , 1987 .

[19]  M. Rosenzweig,et al.  HIV‐1 and the thymus , 1997, AIDS.

[20]  S. Cole,et al.  Norepinephrine accelerates HIV replication via protein kinase A-dependent effects on cytokine production. , 1998, Journal of immunology.

[21]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.

[22]  N. Schneiderman,et al.  Psychoneuroimmunology and HIV-1. , 1990, Journal of Consulting and Clinical Psychology.

[23]  S. Hollon,et al.  Defining empirically supported therapies. , 1998, Journal of consulting and clinical psychology.

[24]  M. Antoni,et al.  Stressful Events, Pessimism, Natural Killer Cell Cytotoxicity, and Cytotoxic/Suppressor T Cells in HIV+ Black Women at Risk for Cervical Cancer , 1998, Psychosomatic medicine.

[25]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[26]  T. Patterson,et al.  Plasma Catecholamine and Lymphocyte beta2 -adrenergic Receptor Alterations in Elderly Alzheimer Caregivers under Stress , 1997, Psychosomatic medicine.

[27]  J. Dimsdale,et al.  Plasma catecholamines in stress and exercise. , 1980, JAMA.

[28]  R. Vries.  1991 MACK FORSTER AWARD LECTURE REVIEW , 1992 .

[29]  N. Schneiderman,et al.  Changes in Cognitive Coping Skills and Social Support During Cognitive Behavioral Stress Management Intervention and Distress Outcomes in Symptomatic Human Immunodeficiency Virus (HIV)-Seropositive Gay Men , 1998, Psychosomatic medicine.

[30]  Douglas A. Bernstein,et al.  Progressive Relaxation Training: A Manual for the Helping Professions , 1973 .

[31]  M. Aladjem.  Urinary catecholamines and metabolites in children. , 1978, The Journal of pediatrics.

[32]  N. Schneiderman,et al.  An Improved Assay of Urinary Catecholamine Metabolites, 3-Methoxy-4-Hydroxyphenylglycol and Vanillylmandelic Acid, Using High Performance Liquid Chromatography With Electrochemical Detection , 1993 .

[33]  G. Carliner,et al.  The economic impact of AIDS in the United States. , 1988, Science.

[34]  M. Hamilton.  The assessment of anxiety states by rating. , 1959, The British journal of medical psychology.

[35]  R. Landmann,et al.  Beta-adrenergic receptors in human leukocyte subpopulations. , 1992, European journal of clinical investigation.

[36]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[37]  F. Keefe,et al.  Sampling of empirically supported psychological treatments from health psychology: smoking, chronic pain, cancer, and bulimia nervosa. , 1998, Journal of consulting and clinical psychology.

[38]  M. Oldstone.  HIV versus cytotoxic T lymphocytes--the war being lost. , 1997, The New England journal of medicine.

[39]  The efficacy and effectiveness of psychotherapy relative to medications. , 1996, The American psychologist.

[40]  G. Ironson,et al.  Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. , 1996, The International journal of neuroscience.

[41]  J. Rabkin,et al.  Treatment of depression in HIV+men: Literature review and report of an ongoing study of testosterone replacement therapy , 1996, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[42]  E. Hull,et al.  The Catecholaminergic Response to Stress and Exercise , 1985 .

[43]  D. Shannahoff-Khalsa,et al.  Alternating lateralization of plasma catecholamines and nasal patency in humans. , 1986, Life sciences.

[44]  J. Martin,et al.  Psychological consequences of AIDS-related bereavement among gay men. , 1988, Journal of consulting and clinical psychology.

[45]  N. Schneiderman,et al.  Psychophysiologic reactions to stress. , 1985 .

[46]  Dc Washington.  Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[47]  Niels Birbaumer,et al.  Biofeedback and self-regulation , 1979 .

[48]  M. Carruthers,et al.  Stress and age effects on catecholamines in normal subjects. , 1981, Journal of psychosomatic research.

[49]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[50]  N. Schneiderman,et al.  Cognitive-behavioral stress management increases free testosterone and decreases psychological distress in HIV-seropositive men. , 2000, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[51]  M. Esler,et al.  Effect of norepinephrine uptake blockers on norepinephrine kinetics , 1981, Clinical pharmacology and therapeutics.

[52]  I. Kopin,et al.  Plasma noradrenaline increases with age , 1976, Nature.

[53]  C. Eisdorfer,et al.  Norepinephrine response in early HIV infection. , 1991, Journal of acquired immune deficiency syndromes.

[54]  D. Perkins,et al.  Severe stress, depressive symptoms, and changes in lymphocyte subsets in human immunodeficiency virus-infected men. A 2-year follow-up study. , 1997, Archives of general psychiatry.

[55]  Martha Davis,et al.  The Relaxation & Stress Reduction Workbook , 1985 .

[56]  R. Elashoff,et al.  A structured psychiatric intervention for cancer patients. II. Changes over time in immunological measures. , 1990, Archives of general psychiatry.

[57]  D Robertson,et al.  Effects of caffeine on plasma renin activity, catecholamines and blood pressure. , 1978, The New England journal of medicine.

[58]  P. Cryer,et al.  Norepinephrine and epinephrine release and adrenergic mediation of smoking-associated hemodynamic and metabolic events. , 1976, The New England journal of medicine.

[59]  G. Brabant,et al.  Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriya yoga training and vegetarian nutrition. , 1997, Acta physiologica Scandinavica. Supplementum.

[60]  M. Schedlowski,et al.  Effects of behavioral intervention on plasma cortisol and lymphocytes in breast cancer patients: An exploratory study , 1994 .

[61]  N. Schneiderman,et al.  8.10 – HIV and AIDS , 1998 .

[62]  N. Schneiderman,et al.  Cognitive-behavioral intervention effects on mood and cortisol during exercise training , 1998, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[63]  B. McEwen.  Protective and damaging effects of stress mediators. , 1998, The New England journal of medicine.

[64]  Janet B W Williams,et al.  A structured interview guide for the Hamilton Depression Rating Scale. , 1988, Archives of general psychiatry.

[65]  N. Schneiderman,et al.  Patterns of immune, neuroendocrine, and cardiovascular stress responses in asymptomatic hiv seropositive and seronegative men , 1996, International journal of behavioral medicine.

[66]  D. Cella,et al.  The influence of stress management training in HIV disease. , 1996, Nursing research.

[67]  G. V. Marie,et al.  Relaxation and stress management in the treatment of essential hypertension. , 1986, Journal of psychosomatic research.

[68]  D. A. J. Tyrrell,et al.  Psychological stress in humans and susceptibility to the common cold , 1997 .

[69]  A. Baum,et al.  Chronic stress, catecholamines, and sleep disturbance at Three Mile Island. , 1987, Journal of human stress.

[70]  S. Folkman,et al.  Appraisal, coping, health status, and psychological symptoms. , 1986, Journal of personality and social psychology.

[71]  D. Papanicolaou,et al.  Modulatory effects of glucocorticoids and catecholamines on human interleukin-12 and interleukin-10 production: clinical implications. , 1996, Proceedings of the Association of American Physicians.

[72]  S. Cobb,et al.  Physiologic changes in men whose jobs were abolished. , 1974, Journal of psychosomatic research.

[73]  J. Kelly,et al.  Behavioral medicine interventions can improve the quality-of-life and health of persons with HIV disease , 1996, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[74]  P. Emmelkamp,et al.  Cognitive‐behavioral and experiential group psychotherapy for HIV‐infected homosexual men: a comparative study. , 1994, Psychosomatic medicine.

[75]  M. McElrath,et al.  Cytotoxic-T-cell responses, viral load, and disease progression in early human immunodeficiency virus type 1 infection. , 1997, The New England journal of medicine.

[76]  N. Schneiderman,et al.  Cognitive-behavioral stress management decreases dysphoric mood and herpes simplex virus-type 2 antibody titers in symptomatic HIV-seropositive gay men. , 1997, Journal of consulting and clinical psychology.

[77]  R. Redfield,et al.  HIV infection: the clinical picture. , 1988, Scientific American.

[78]  S. Folkman,et al.  Psychological impact of HIV disease and implications for intervention. , 1994, The Psychiatric clinics of North America.

[79]  D. Richman,et al.  Recovery of replication-competent HIV despite prolonged suppression of plasma viremia. , 1997, Science.

[80]  J. Gorman,et al.  Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. II. Standardized clinical assessment of current and lifetime psychopathology. , 1991, Archives of general psychiatry.

[81]  K. Madden,et al.  Catecholamine influences and sympathetic neural modulation of immune responsiveness. , 1995, Annual review of pharmacology and toxicology.

[82]  M. Lorr,et al.  Manual for the Profile of Mood States , 1971 .

[83]  J. Kiecolt-Glaser,et al.  Handbook of human stress and immunity , 1994 .

[84]  M. Drake.  Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.) , 1988 .

[85]  N. Schneiderman,et al.  Cognitive-behavioral stress management intervention buffers distress responses and immunologic changes following notification of HIV-1 seropositivity. , 1991, Journal of consulting and clinical psychology.

[86]  G. Chrousos,et al.  The role of corticotropin-releasing hormone in neuroendocrine-immune interactions , 1997, Molecular Psychiatry.

[87]  L. Y. Stevenson,et al.  Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. , 1993, The American journal of psychiatry.

[88]  K. Donelan,et al.  Discrimination against people with AIDS: the public's perspective. , 1988, The New England journal of medicine.

[89]  C. Eisdorfer,et al.  A Simplified HPLC-ECD Technique for Measurement of Urinary Free Catecholamines , 1991 .

[90]  Cathy H. McKinney,et al.  Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults. , 1997, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[91]  N. Schneiderman,et al.  Psychosocial counseling to improve quality of life in HIV infection. , 1994, Patient education and counseling.

[92]  N. B. Ingels,et al.  Effects of Relaxation Therapy on Cardiac Performance and Sympathetic Activity in Patients with Organic Heart Disease , 1979, Psychosomatic medicine.

[93]  G. Davison,et al.  Noradrenergic hyperactivity in primary hypertension; central and peripheral markers of both behavioral pathogenesis and efficacy of sympatholytic and relaxation therapy. , 1988, Clinical and experimental hypertension. Part A, Theory and practice.

[94]  M. Ziegler.  Catecholamine Measurement in Behavioral Research , 1989 .

[95]  Jude M. Brown.  Imagery coping strategies in the treatment of migraine , 1984, Pain.