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),
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
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
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
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.