My citation abstract, explained.
Dec. 7th, 2005 12:10 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
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.
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.
no subject
Date: 2005-12-07 05:18 pm (UTC)no subject
Date: 2005-12-07 05:22 pm (UTC)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.
no subject
Date: 2005-12-07 05:26 pm (UTC)[Both this comment and your research as a whole.]
no subject
Date: 2005-12-07 05:42 pm (UTC)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?
no subject
Date: 2005-12-07 06:19 pm (UTC)no subject
Date: 2005-12-07 06:23 pm (UTC)-J
no subject
Date: 2005-12-07 07:09 pm (UTC)"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."
no subject
Date: 2005-12-07 09:14 pm (UTC)no subject
Date: 2005-12-07 10:04 pm (UTC)no subject
Date: 2005-12-07 10:42 pm (UTC)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.
no subject
Date: 2005-12-07 05:41 pm (UTC)I would be interested in reading more of what you have to say about this in simple words like above article.
no subject
Date: 2005-12-07 05:48 pm (UTC)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.
no subject
Date: 2005-12-07 06:28 pm (UTC)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.
no subject
Date: 2005-12-07 06:21 pm (UTC)no subject
Date: 2005-12-07 06:38 pm (UTC)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.
no subject
Date: 2005-12-07 06:24 pm (UTC)I'm just sad it's not in Banff.
-J
no subject
Date: 2005-12-07 06:32 pm (UTC)no subject
Date: 2005-12-07 06:24 pm (UTC)no subject
Date: 2005-12-07 06:42 pm (UTC)no subject
Date: 2005-12-07 07:17 pm (UTC)no subject
Date: 2005-12-07 08:41 pm (UTC)This is neat...
Date: 2005-12-08 03:59 am (UTC)Re: This is neat...
Date: 2005-12-08 10:05 pm (UTC)no subject
Date: 2005-12-08 05:29 pm (UTC)no subject
Date: 2005-12-08 10:06 pm (UTC)no subject
Date: 2005-12-08 07:18 pm (UTC)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.