1. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 1 The stimulus

2. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 2 Self-efficacy: Sources of efficacy judgments  Feedback re: behavioral subgoals ( Cf: Karoly, Carver models)  Sub-goals: concrete, specific  discernable feedback  Attitude change: Behavior  attitude  “Guided mastery” interventions  Modeling  Bandura & Walters:  Coping model >> Mastery model  Controls resources > rewarded > simple performance  Similarity of model to participant: Peer-based interventions  Social persuasion  Normative / personal information  Social network mechanism?  Feedback post performance > simple attitude change  Interpretation of somatic information  E.g., “fear of fear”  Cognitive representation of disease  Miller C-SHIP model: Rx to “hot” disease or physical information

3. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 3 Perceived control and stress  Averill, types of control:  Behavioral  Brown: Bereavement  stress  mortality  Learned helplessness  Decisional  Singer: stress Rx & perceived controllability  Interpretative  Taylor: “search for meaning” & coping w/cancer  “Hopelessness” & depression  Predictive  DV literature / Averill data: predictability >> aversiveness

4. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 4 Efficacy training  immune system Immune parameters x Efficacy training stage x “Enhancer” v. “Suppressor” group

5. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 5 Perceived control & stress, 2  Bandura;  Consequences of low perceived control  Subjective stress & negative affect  Health risk behavior  Autonomic activation  HPA activation  Plasma catecholamine secretion  HPA activation  decreased lymphocyte proliferation  Induced self-efficacy  Rapid efficacy gain  immuno-enhancing  High cortisol release  immuno-suppressant

6. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 6 Ideal Self-discrepancies & affect ActualOught Depression, disappointment OwnOtherOwnOtherOwnOther Dejection, loss of esteem Fear, perceived threat Guilt, self-recrimination Anxiety, fear, social anxiety Depression, sadness, self-disappointment

7. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 7 Self-discrepancy model of stress. Acute negative self- appraisal Chronic availability of self-discrepancy Ideal :: Actual Ought :: Actual Chronic availability of self-discrepancy Ideal :: Actual Ought :: Actual Contextual activation of self- discrepancy Negative affect Depression Anxiety Negative affect Depression Anxiety NK suppression Cortisol secretion Actual (self- rated) stressful events ? ??

8. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 8 Primed self-discrepancies  NK activation “Normal” Ss show immune enhancement after priming with yoked stimuli Dysphoric Ss show immune suppression after self-priming with “ideal” stimuli Anxious Ss show immune suppression after self- priming with “ought” stimuli

9. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 9 Robles et al.: Balanced immune responses  Inflammation :  attracts immune cells to injury site  Induce adaptive “sickness behavior”  Activates HPA axis  HPA activation:  Stimulates cortisol production  Down-regulates pro- inflammatory cytokines Macrophages etc.

10. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 10 Robles: Stress – modulated immune responses. A. Brain effects of stress:  Reduce glucocorticoid receptors  Disrupt receptor functioning  Dysregulate HPA axis  Decrease threshold for HPA arousal in response to stress  Possible chronic HPA arousal  Cortisol production Immune suppression

11. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 11 Robles: Stress – modulated immune responses, 2. B. Cellular effects of stress:  Disrupt functioning of corticoid receptors on cytokine-producing cells  Less sensitive to the anti- inflammatory effects of cortisol

12. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 12 Robles: Stress – modulated immune responses, 2. C. Immune suppression from stress / negative affect:  HPA activation  cortisol  immune suppression  Inhibits ability to fight off infection  Chronic infections  Inflammation

13. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 13 Robles: Stress – modulated immune responses, 2. D. Proinflammatory cytokines  Reduce or disrupt glucocorticoid receptors in the brain  All four mechanisms  Chronic elevated production of proinflammatory cytokines  Direct effects on chronic disease and pathophysiology  Indirect via, e.g., production of C- reactive protein. CRP

14. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 14 Behavioral intervention designs  Stress management  Education  Cognitive restructuring (simplified CBT)  Coping skills training  Support provision  Relaxation  Deep muscle  “Autogenic”  Mindfulness  Disclosure  Kemeny group: disclosure of sexual orientation  Pennebaker: systematic writing / “uplifting” language Not typical: direct affect regulation (DBT) skills.

15. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 15 Stress & coping model of immune supression Appraisal Coping Subjective (dis)stress Approach / active coping Avoidant / affective coping Unmeasured moderators Chronic (?) stress Arousal & activity Risk behavior: tobacco, etoh, drugs & sex… Risk behavior: tobacco, etoh, drugs & sex… Perceived threat / vulnerability Perceived control / self- efficacy Perceived Stress Life events Catecholamine / corticosteroid / HPA  cellular & humoral immune cascade Catecholamine / corticosteroid / HPA  cellular & humoral immune cascade Ψ closeness Mediating responses

16. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 16 Alternate conceptualization Appraisal Coping Approach / active coping Avoidant / affective coping Chronic (?) stress Arousal & activity Risk behavior: tobacco, etoh, drugs & sex… Risk behavior: tobacco, etoh, drugs & sex… Perceived threat / vulnerability Perceived Stress Catecholamine / corticosteroid / HPA  cellular & humoral immune cascade Catecholamine / corticosteroid / HPA  cellular & humoral immune cascade Negative affect Perceived control / self- efficacy Depression Neuroticism Poor affect regulation Affect or thought suppression Depression Neuroticism Poor affect regulation Affect or thought suppression

17. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 17 Stress & coping intervention model Appraisal Coping Subjective (dis)stress Approach / active coping Avoidant / affective coping Arousal & activity Risk behavior: tobacco, etoh, drugs & sex… Risk behavior: tobacco, etoh, drugs & sex… Perceived threat / vulnerability Perceived control / self- efficacy Mediating responses Cognitive reframing, Basic CBT techniques  Bandura-esque self- efficacy training  Coping skills training  Relaxation training Depression treatment  Behavioral interventions 

18. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 18 Thorton et al., Relaxation training  NA  inflammation  Study population  n = 45 breast cancer patients w / “clinically significant” depression scores on CES-D  (20% of patient population)  M = 45 days post-surgery  Intervention  Group-based (8-12 pt.)  4 months of weekly 90 min. sessions, 8 months of monthly sessions  Targets:  reduce stress & emotional distress  enhance social adjustment,  improve compliance with cancer treatment  enhance health behaviors.

19. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 19 Thorton et al., results  Clear effects on 3 core Ψ outcomes:  Depression  Fatigue  Pain tolerance  Asymptote about 8 months

20. Psychology 415; Social Basis of Health Behavior Psychoimmunology 2 20 Thorton et al., results, 2  More modest, but significant effects on immune / inflammation markers  WBC counts  T helper :: suppressor ratio  Δ in Ψ variables  less inflammation