My citation abstract, explained.

[rivka]

This is the first major finding from our big five-year study of stress, coping, and immune function in HIV. In a previous study, we found that a specific coping pattern - suppression or even total non-recognition of negative emotions, a focus on others' needs rather than one's own, and an outward appearance of being Just Fine - was associated with a decreased immune response to HIV. Now we're trying to (a) replicate that finding with a larger and more carefully-selected sample of patients, and (b) figure out how it works. A major hypothesis is that people with the coping style in question (known as Type C coping) have an abnormal physiological response to stress.

So, as part of our research protocol, we bring patients into the lab and stress them out while we monitor their physiological responses - blood pressure, heart rate, maximal arterial pressure. First, we ask them to tell about a recent situation that made them angry. We help rev up the emotions with our reactions ("My God, I can't believe she said that - that's totally unfair!"). Then we tell them to stop thinking about the angry situation and "make yourself relaxed and calm."

The second half of the stress procedure is a role play. We tell patients to pretend that the experimenter is their doctor, and has prescribed a medicine that's causing terrible side effects. They are to complain about the side effects, amd the experimenter plays the role of the doctor. What we don't tell them: the "doctor" is rude, dismissive, and insulting. ("Oh, for heaven's sake, what is it now? ...You think another medicine would be better for you? Well, when did you go to medical school?") After the role play, again, they're supposed to make themselves relaxed and calm.

What we're finding is that patients who have greater increases in heart rate and blood pressure during the test periods and/or lesser ability to reduce their heart rate and blood pressure in the "make yourself relaxed and calm" recovery period, have a poorer immune response to HIV.

We take samples of the patients' blood and expose it to different antigens - things the immune system ought to defend against. Then we measure the amount of various immune products that are produced in response to the antigen. We're specifically interested in beta-chemokines, which bind to the same receptors on CD4+ (T-helper) cells that HIV needs to bond to, therefore blocking HIV from entering the cell. So when we challenged patients' blood with the core protein of HIV, the ones who had greater cardiovascular reactivity on the stress tests and poorer recovery afterward produced lower amounts of beta-chemokines. this was specific to the HIV antigen - it didn't apply to either of the standard research antigens we used in addition to the core HIV protein.

We still need to work out how this relates to coping, especially the Type C coping style, but it's a fascinating piece of evidence for how stress affects the immune system in people with HIV.

Comments

[rysmiel.livejournal.com]

Googling on "type C coping" seems to find a lot of studies linking it with physical illness in ways akin to yours rather than anything definitional; what are types A and B defined as ?

[rivka.livejournal.com]

Type A coping, also known as the "Type A personality," is an emotionally overexpressive, hostile, highly reactive way of dealing with stress. It's pretty much the polar opposite of Type C. My boss was the first person to identify the Type C coping style, in a study of whether Type A might be related to cancer progression. "These are the least Type A people I've ever seen," she said, and a research career was born.

Type A coping is strongly linked to cardiovascular disease. Type C coping is linked to immune dysfunction - specifically, faster disease progression in cancer and HIV.

Type B is the middle ground - a healthy, moderate response to stress.

[cheshyre]

Oh, fascinating...
[Both this comment and your research as a whole.]

[irismoonlight.livejournal.com]

So....this might seem out of the blue, but it makes perfect sense to ME:
How many of those with Type C coping have PTSD, are trauma survivors, or came from abusive childhoods? Do any of them NOT have one of those three?

[rivka.livejournal.com]

Typically Type C copers had absolutely dreadful childhoods - a history of repeated trauma, abuse, or abandonment. But that's a clinical impression - it's based on the people my boss and I have seen in therapy. We don't really know anything about the backgrounds of Type C copers who are out there in the community, not presenting with a problem.

[therealjae.livejournal.com]

I want to know the answer to this, too!

-J

[johnpalmer.livejournal.com]

I wouldn't be surprised if some didn't. Part of it is the "keep your chin up and ignore the problem, and keep up with your responsibilities" which is the advice a lot of folks give to people who are feeling troubled in the US (at least, in places where I've lived).

"Eh, it's rough, but I can take it. I'm no whiner. I'm not a complainer. And I'm not going to get feeling all sorry for myself and ignore everyone else, because only a wimp would do that."

[beckyzoole.livejournal.com]

So, this study seems to show that Type A is linked to immune disfunction too?

[rivka.livejournal.com]

No, not necessarily. We didn't assess for Type A at all, but the people who show the most physiological response to stress aren't necessarily the ones who are also the most emotionally expressive. For example, Type C folks often have strong physiological responses to stress - but if you ask them, they'll say they're not especially upset. And Type A people can actually feel more ups and downs than are reflected in their physiological response.

[beckyzoole.livejournal.com]

It sounds like with Type C personalities, the damage may come not so much from the behavior itself, as from the underlying inability to recognize stress that that behavior reflects. They don't recognize the physiological response as "stress", so they fail to try to remove the stressor.

Do Type C people show this disconnect between body and emotion in other areas? Do they tend to not fall in love as easily, not bond to children as tightly, or, heck, even not startle as reflexively at a loud noise? It would be very interesting to see if this is a general hyposensitivity to "molecules of emotion", or specific to stress only.

[ailbhe]

Wow, that's fascinating. And exciting. Woo!

I would be interested in reading more of what you have to say about this in simple words like above article.

[kightp.livejournal.com]

That's flat-out fascinating - and, I might add, very well-explained in terms a relative layperson can understand, which suggests that you probably write terrific abstracts. (-:

It makes me wonder all sorts of things - whether the coping reaction is chicken or egg, cause or effect, for instance? Is it possible that the poor immune response actually *causes* a person to be physiologically less capable of coping with stress? Or is it necessarily the other way around? What sort of study would it take to answer a question like that?

I know that my own ability to fend off and recover from minor illnesses has improved dramatically over time, coincident with learning ways to cope with stress that don't involve screaming, crying and hitting things. This proves exactly nothing, of course, but it makes me go "Oh, of course!" when I read about your study.

I love this mind-body stuff. I love knowing somebody who's doing actual research about it, too.

[rivka.livejournal.com]

Is it possible that the poor immune response actually *causes* a person to be physiologically less capable of coping with stress? Or is it necessarily the other way around? What sort of study would it take to answer a question like that?

What's needed is a prospective study, where you measure the stress response at Time 1 and then look at immune function in the future, at Time 2 and beyond.

This has been done for the Type C coping-immune dysfunction connection: they examined coping styles in perfectly healthy HIV+ men, no symptoms or significant immune decline, and then looked to see how the disease was progressing 18+ months later.

It's also been done with Type A: it's clear that the high reactivity to stress predates cardiovascular disease rather than being a response to it.

[jonquil.livejournal.com]

I know this isn't your research specialty, but now I'm dying to know how Type C coping affects the health of non-AIDS patients.

[rivka.livejournal.com]

Type C was initially identified in malignant melanoma patients, and was found to be related to a number of health outcomes: increased delay in seeking treatment for symptoms, faster disease progression, greater tumor depth, lesser lymphocyte (white blood cell) activity at the tumor site.

Anecdotally, I think that Type C coping can be involved in some pain syndromes. Type C copers tend not to realize that they're under stress, and so they stay in stressful situations. The body's need for relief can manifest as pain - for example, migraines, in one clinical case I saw. My client's migraines got much better once she started noticing symptoms of stress and the need to relax before she got to the crippling-pain-ER-visit stage.

[therealjae.livejournal.com]

Oh, I love this part of your research. Go you on the presentation. May it be a huge hit.

I'm just sad it's not in Banff.

-J

[rivka.livejournal.com]

Me too! All Citation Abstracts should be celebrated with dinner at the Grizzly House. To say nothing of other pleasures which are sometimes possible in Banff. ;-)

[nixve.livejournal.com]

ooh, this is fascinating stuff!

[lysana.livejournal.com]

Huh. I begin to think you've found my personality type. Heh.

[johnpalmer.livejournal.com]

Fascinating stuff... and wow, I'm glad someone noticed the "anti-type-A" pattern and studied it.

[lietya.livejournal.com]

Wow, that's all just fascinating!

This is neat...

[tendyl.livejournal.com]

See I love reading about your research and work. It expands my horizons. Have you found or has someone found that people who work relaxation into their life are less likely to have immune dysfunctions?

Re: This is neat...

[rivka.livejournal.com]

There's plenty of research to show that stress-reduction interventions, such as teaching people how to meditate, boosts immune function.

[sashajwolf.livejournal.com]

That's fascinating stuff (and I must now resist the temptation to classify everyone around me into Type A, B or C!) Thanks for explaining it.

[rivka.livejournal.com]

Just to add to the confusion, several different people have proposed a Type D, except that they don't agree on what it consists of. ;-)

[xopher-vh.livejournal.com]

Someone once asked me if I was "a Type A personality." I replied "Is there a Type Z?"

Not true of course, but a good line. Not as good as when my magician friend Jeff commented that he loved going to Taipei on tour...

This is fascinating. Congratulations again. And now I know why I hardly ever get sick since I've been on meds for the ADHD (which for me included periodic attacks of frustration-rage) and antidepressants. I take good care of myself, but I always did, and I used to get sick anyway.