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1. Antoni, M.H. (1991). Psychosocial Stressors and Behavioral Interventions in Gay Men with HIV Infection. International Review of Psychiatry, 3, 383-399.
This paper discusses how social changes faced by HIV-1 positive homosexual men may overwhelm previously learned coping strategies. These men may then suffer from a loss of perceived self-efficacy, feelings of hopelessness and depression, and increases in maladaptive behaviors which may, in turn, compromise future physical health status. Behaviour interventions that increase self-efficacy, encourage emotional expression, and increase social support resources in a supportive group environment are set forth. Studies are cited which illustrate various behavioral interventions and immunological changes associated with these interventions.

2. Antoni, M.H., Baggett, L., Ironson, G., LaPerriere, A., August, S., Klimas, N., Schneiderman, N., & Fletcher, M.A. (1991). Cognitive-Behavioral Stress Management Intervention Buffers Distress Responses And Immunologic Changes Following Notification of HIV-1 Seropositivity. Journal of consulting and Clinical Psychology, 59 (6), 906-15.
In this study, 47 asymptomatic, healthy gay men were randomly assigned to a cognitivebehavioral stress management (CBSM) group or an assessment-only control group 5 weeks before being notified of their HIV -1 antibody status. Seventy-two hours before and 1 week after serostatus notification, blood samples and psychometric data were collected. Control subjects showed significant increases in depression, but only slight decrements in mitogen responsivity and lymphocyte cell counts pre- to postnotification of seropositivity. Seropositive CBSM subjects did not show significant pre-post changes in depression, but did reveal significant increases in helper-inducer (CD4) and natural killer (CD56) cell counts as well as a slight increment in mitogen responsivity. The authors conclude that the psychological buffering and immunomodulating effects of the CBSM manipulation may be attributable, in part, to relaxa:tion skills learned and practiced or to a general willingness to comply with the intervention guidelines.

3. Domar A, Clapp D, Slawsby E, Dusek J, Kessel B, Freizinger M. Impact of Group Psychological interventions on pregnancy rates in infertile women. Fertility and Sterility 2000: 73; 4: 805-11.

4. Fawzy, F.I., Fawzy, N.W., Hyun, C.S., Elashoff, R., Guthrie,D., Fahey, J.L., & Morton, D.L. (1993). Malignant Melanoma. Effects Of An Early Structured Psychiatric Intervention, Coping, And Affective State On Recurrence And Survival 6Years Later. Archives of General Psychiatry 50 (9), 681-689.
This study evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier, shortly after their diagnosis and initial surgical treatment. The results showed that there was a statistically significant greater rate of death for control patients than for experimental patients. Analysis of multiple covariates found that only Breslow depth and treatment (ie~ group intervention) were significant. Adjusting for Breslow depth, treatment effect remained significant. Finally, baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival. Surprisingly, higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death. The authors conclude that psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease.

5. Fawzy, F.I., Cousins, N.; Fawzy, N.W.; Kemeny, M.E.; Elashoff, R., & Morton, D. (1990). A Structured Psychiatric Intervention For Cancer Patients. I. Changes Over Time In Methods Of Coping And Affective Disturbance. Archives of General Psychiatry 47(8), 720-725.
This study evaluated the immediate and long-term effects on psychological distress and coping methods of a 6-week, structured, psychiatric group intervention for postsurgical patients with malignant melanoma. The intervention consisted of health education, enhancement of problem-solving skills, stress management ( e.g., relaxation techniques), and psychological support. In spite of good prognosis, most patients had high levels of psychological distress at baseline, comparable with other patients with cancer. However, at the end of brief psychiatric intervention, the 38 experimental subjects exhibited higher vigor and greater use of active-behavioral coping than the 28 control subjects. At 6 months' fo1low-up~ the group differences were even more pronounced. The intervention-group patients then showed significantly lower depression, fatigue, confusion, and total mood disturbance as well as higher vigor. These results indicate that a short-term psychiatric group intervention for patients with malignant melanoma effectively reduces psychological distress and enhances longer-term effective coping.

6. Fawzy, F.I., Kemeny, M.E., Fawzy, N. W., Elashoff, R., Morton, D., Cousins, N., & Fahey J.L. (1990). A Structured Psychiatric Intervention For Cancer Patients. II. Changes Over Time In Immunological Measures. Archives of General Psychiatry 47(8),729-735.
This study evaluated the immediate and long-term effects on immune function measures of a 6-week structure psychiatric group intervention for patients with malignant melanoma. Along with a reduction in levels of psychological distress and greater use of active coping methods, the following immune changes were seen at the 6-month assessment point in the 35 intervention-group patients compared with the 26 control subjects: significant increases in the percent of large granular lymphocytes and natural killer (NK) cells along with indications of increase in NK cytotoxic activity; and a small decrease in the percent of CD4 (helper/inducer) T cells. At the 6-week follow-up point, the majority of these changes were not yet observable. The results indicate that a short-term psychiatric group intervention in patients with malignant melanoma with a good prognosis was associated with longer-term changes in affective state, coping, and the NK lymphoid cell system.

7. Hamilton, L. (1989). Fight, Flight Or Freeze: Implications Of The Passive Fear Response For Anxiety And Depression. Phobia Practice & Research Journal, 2(1) , 17-27.
The General Adaptation Syndrome (GAS) or "fight or flight" response mediated by the sympathetic nervous system is well-known. This paper addresses what is called the General Inhibition Syndrome (GIS) or "freeze or hide" response mediated by the parasympathetic nervous system. This type of response is found in post-traumatic stress disorders and the extreme avoidance and depression reported by some agoraphobics. Treatment implications of this response are discussed.

8. House, J.S., Landis, K.R., Umberson, D. Social relationships and health. Science 1988; 241: 540-545.

9. NIH Technology Assessment Panel. (1996). Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. JAMA, 276(4),313-318.
This article is a report of the NIH Technology Assessment Panel on the integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. The Technology Assessment Conference reviewed data on the relative merits of specific behavioral and relaxation interventions and identified biophysical and psychological factors that might predict the outcome of applying these techniques; They also examined the mechanism by which behavioral and relaxation approaches could lead to greater clinical effectiveness. The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medical conditions as well as strong evidence for, the use of hypnosis in alleviated pain associated with cancer. The evidence was moderate for the effectiveness of cognitive behavioral techniques and biofeedback in relieving chronic pain. Regarding, insomnia, behavioral techniques, particularly relaxation and biofeedback produce improvements in some aspects of sleep, but it is questionable whether the magnitude of the improvement in sleep onset and total sleep time are clinically significant.

10. Ornish, D. et al. (1990). Can Lifestyle Changes Reverse Coronary Heart Disease? Lancet, 336, 129-133.
This prospective, randomized, controlled trial was performed to determine whether comprehensive lifestyle changes affect coronary artherosclerosis after 1 year. Twenty eight patients were assigned to an experimental group and 20 to a usual-care group. The lifestyle changes in the experimental group included a, low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise. Angiography was used to assess changes in coronary atherosclerosis. After a year, patients in the experimental group showed significant overall regression of coronary atherosclerosis. Overall 82% of the experimental group patients had an average change towards regression. Results of this study suggest that comprehensive lifestyle changes may be able to bring about regression of even severe coronary athlerosclerosis after only 1 year, without the use of lipid-lowering drugs.

11. Shrock, D., Palmer, R.F ., & Taylor, B. (1999). Effects of a Psychosocial Intervention on Survival Among Patients with Stage I Breast and Prostate Cancer: A Matched Case-Control Study. Alternative Therapies in Health and Medicine, 5(3),49-55.
The objective of this study was to investigate the effects of a 6-week psychosocial intervention on the survival among patients with stage I breast and prostate cancer. Twenty one breast and 29 prostate cancer patients were matched with 74 breast and 65 prostate cancer patients who did not receive the intervention. The psycho educational intervention included topics and discussions on the following: (1) the effect of one's beliefs, feelings, and attitudes on health; (2) mental relaxation and imagery techniques, nutrition, and exercise; (3) stress management; (4) self-esteem and spirituality; (5) receptive imagery/intuition and problem solving; and (6) creating a personal health plan/goal setting. Survival time was compared between the 2 groups and with national norms. Results showed that the intervention group lived significantly longer than did the matched controls. These results are consistent with prior clinical trials and suggest that short-tenn psychosocial interventions that encourage the expression of emotions, provide social support, and teach coping skills can influence survival among cancer patients.

12. Smyth, I. M., Stone, A.A., Hurewitz, A, & Kaell, A. (1999). Effects of Writing About Stressful Experiences of Symptom Reduction in Patients with Asthma or Rheumatoid Arthritis., JAMA 281(1), 1304-1309.
The objective of this study was to determine if writing about stressful live experiences affects disease status in patients with asthma or rheumatoid arthritis. One hundred seven patients completed the study. Patients were assigned to write either about the most stressful event of their lives. A control group was asked to write about emotionally neutral topics. Assessments were conducted at baseline and at 2 weeks, 2 months, and 4 months after the writing sessions which consisted of three 20 minute sessions on three consecutive days. Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were examined by a rheumatologist. Combining all completing patients 47% of the experimental patients had clinically relevant improvement whereas 24% of control patients had improvement at the 4 month follow-up, The authors note that these gains were beyond those attributable to the standard medical care that the participants were receiving, but it remains unlo1own whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases.

13. Spiegel, D. et al. (1989). Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer. Lancet,2, 888-891.
This study was a 10 year follow-up to a previous study in order to determine the effect of psychosocial intervention on the time of survival of 86 patients with metastatic breast cancer. The 1 year intervention consisted of a weekly supportive group therapy with self hypnosis for pain. Both the treatmnent and control groups had routine oncological care. At 10 year follow-up, only 3 of the patients were alive, and death records were obtained for the other 83. Survival time for the treatment group was significantly longer compared with controls. In addition, the interval from fist metastasis to death was significantly longer for the group randomized to treatment. Th\1S the intervention group lived on average twice as long as did controls.

 
 
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