Arguelles, Lester M./ Afari, Niloofar/ Buchwald, Dedra S./ Clauw, Daniel J./
Furner, Sylvia/ Goldberg, Jack. A twin study of posttraumatic stress disorder symptoms and chronic widespread pain. Pain 2006, 124, 150–157.
Abstract
Previous studies of the association between posttraumatic stress disorder (PTSD) and chronic widespread pain (CWP) or fibromyalgia have not examined the role of familial or genetic factors. The goals of this study were to determine if symptoms of PTSD are related to CWP in a genetically informative community-based sample of twin pairs, and if so, to ascertain if the association is due to familial or genetic factors. Data were obtained from the University of Washington Twin Registry, which contains 1042 monozygotic and 828 dizygotic twin pairs. To assess the symptoms of PTSD, we used questions from the Impact of Events Scale (IES). IES scores were partitioned into terciles. CWP was defined as pain located in 3 body regions lasting at least 1 week during the past 3 months. Random-effects regression models, adjusted for demographic features and depression, examined the relationship between IES and CWP. IES scores were strongly associated with CWP (P < 0.0001). Compared to those in the lowest IES tercile, twins in the highest tercile were 3.5 times more likely to report CWP. Although IES scores were associated with CWP more strongly among dizygotic than among monozygotic twins, this difference was not significant. Our findings suggest that PTSD symptoms, as measured by IES, are strongly linked to CWP, but this association is not explained by a common familial or genetic vulnerability to both conditions. Future research is needed to understand the temporal association of PTSD and CWP, as well as the physiological underpinnings of this relationship.

Beck, Richard. Communion and Complaint: Attachment, Object-Relations, and Triangular Love Perspectives on Relationship with God. Journal of Psychology and Theology 2006, 34(1), 43-52.
The present study attempted to find empirical connections between the attachment, object-relations, and triangular love perspectives as they apply to relationship with God. Attachment to God and object-relations perspectives on God have already been extensively investigated in the literature. In this study, it was observed that the triangular love model (Sternberg, 1986) could also be applied to relationship with God. Using established instruments from each literature—attachment, object-relations, triangular love—it was observed that two factors best explained the correlations among these instruments. The first factor, “Communion,” describes the degree of intimacy, closeness, dependency, and trust in the God-relationship. The second factor, “Complaint,” describes the degree of disappointment and/or frustration involved in the God-relationship. Because these two factors—Communion and Complaint—are orthogonal, it is argued that the commingling of Communion and Complaint in the God-relationship is one feature that can imbue this relationship with an emotional dynamic similar to that observed in human love relationships.

Ben-Ezra, Menachem/ Essar, Nir/ Saar, Ronen. Short Communication: Post - traumatic reactions among rescue personnel before and after exposure to trauma: a brief report. Stress and Health 2006, 22, 337–340.
Summary
There are only a few studies that check rescue personnel before and after exposure to trauma. Peritraumatic dissociation and post-traumatic reactions were examined among rescue personnel in a rescue course and 36–48 h after exposure to a gas pipe explosion in Tel Aviv. The entire rescue personnel were examined for peritraumatic dissociation and post-traumatic reactions. Only those with prior measurements of peritraumatic dissociation and post-traumatic reactions were eligible for analysis. The results showed that the only significant increase among rescue personnel was in peritraumatic dissociation between before in comparison to after exposure to trauma. No significant change was found in avoidance, intrusion, and post-traumatic symptoms. These results correspond with previous studies that found increased peritraumatic dissociation among rescue personnel as a function of exposure severity. Explanations for these results are discussed.

Bicknell, Martin/ Liefooghe, Andreas. The art of stress. Journal of Occupational and Organizational Psychology 2006, 79, 377–394.
This article argues that the later work of Foucault, notably that set out in The History of Sexuality, can make a useful contribution to organizational and occupational psychology. It goes on to analyse accounts of stress, related by client-service workers during interviews, using concepts informed by this work. Such a method of analysing a key work experience takes us beyond the positivism that dominates the large stress literature. Our emphasis is on Foucault’s ideas relating to the creation of oneself as a work of art and the moral problematization of pleasure, rather than the more commonly applied  surveillance and disciplinary controls. We consider stress discourse in this light and note the often overlooked heterogeneity of these stress accounts and
self-portraits. We note that creation of self may itself be a ‘stressful’ process. This use of Foucault allows a rich reading of stress discourses and could, the authors believe, be applied in other organizational and occupational research.

Brattberg, Gunilla. PTSD and ADHD: underlying factors in many cases of burnout. Stress and Health 2006, 22, 305–313.
Summary
Objective: To analyse the extent to which traumatic life events, post-traumatic stress disorder (PTSD) and the neuropsychiatric disorder attention deficit hyperactivity disorder (ADHD) can be contributors associated with burnout and the long-term sick leave that results from it.
Subjects: Sixty-two individuals on long-term sick leave due to stress-related poor health and burnout, and 83 working individuals were screened for the presence of traumatic life events, PTSD and ADHD. Potential background factors involved in burnout were analysed using a multiple logistic regression.
Results: Fifty-two per cent of those on long-term sick leave were judged to have PTSD and 24 per cent to have ADHD. The number of suspected/possible cases was even higher—71 per cent and 56 per cent, respectively. Nineteen per cent were judged to have both PTSD and ADHD; 56 per cent were judged to have PTSD and/or ADHD. PTSD, ADHD and traumatic life events in the form of sexual assault and severe human suffering were all strongly associated with both
burnout and long-term sick leave.
Conclusions: Since ADHD is almost never discussed and PTSD rarely so in the occupational rehabilitation of individuals with burnout, these results should act as a warning signal. Further studies are needed, however, including clinical examinations in order to establish with certainty if PTSD and ADHD can predict burnout followed by long-term sick leave.

Brosschot, Jos F./ Gerin, William/ Thayer, Julian F. The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research 2006, 60, 113– 124.
Abstract
Perseverative cognition, as manifested in worry and rumination, is a common response to stress, but biopsychological models of stress and health have largely ignored it. These models have generally focused on physiological activation that occurs during stress and have insufficiently addressed effects that occur in anticipation of, or following, stressful events. We argue that perseverative cognition moderates the health consequences of stressors because it can prolong stress-related affective and physiological activation, both in advance of and following stressors. We review evidence that worry, rumination, and anticipatory stress are associated with enhanced cardiovascular, endocrinological, immunological, and neurovisceral activity. The findings yield preliminary support for our hypothesis, suggesting that perseverative cognition
might act directly on somatic disease via enhance activation via the cardiovascular, immune, endocrine, and neurovisceral systems.

Cade, C. Maxwell and Coxhead, N., The Awakened Mind: Biofeedback and the Development of Higher States of Awareness, New York: Delacorte Press/Eleanor Friede 1978. Brainwave biofeedback, examining right and left cerebral hemispheric functions

Carmody, James/ Crawford, Sybil/ Churchill, Linda. A pilot study of mindfulness-based stress reduction for hot flashes. Menopause: The Journal of The North American Menopause Society 2006, 13(5), 760-769.
Abstract
Objective: A variety of results from both population and laboratory studies suggest that stress and hot flashes (HFs) are correlated and that HFs are more severe in women with lower coping abilities. The objective of this pilot study was to obtain information on the feasibility and effect of participation in a mindfulness-based stress reduction (MBSR) program on HF severity and menopause-related quality of life.
Design: Fifteen women volunteers reporting a minimum of seven moderate to severe HFs per day at study intake attended the eight weekly MBSR classes at the University of Massachusetts Medical School. Participants were assessed for menopause-related quality of life before beginning and at the conclusion of the MBSR program. Women also kept a daily log of their HFs through the course of the 7 weeks of the MBSR program and for 4 weeks after it.
Results: Women’s scores on quality-of-life measures increased significantly, and the median reported HF severity, calculated as the weekly average of a daily HF severity score, decreased 40% over the course of the 11 weeks of the assessment period. The women were individually interviewed at the completion of their participation, and the results of the interviews were consistent with the results from daily diaries.
Conclusions: These results provide preliminary positive evidence of the feasibility and efficacy of MBSR in supporting women who are experiencing severe HFs, and it warrants further investigation.

Chan, Cecilia L.W./ Tso, Ivy F./ Ho, Rainbow T.H./ Ng, S.M./ Chan, Celia H.Y./
Chan, Juliana C.N./ Lai, Julian C.L./ Evans, Phil D. Short Communication: The effect of a one-hour Eastern stress management session on salivary cortisol. Stress and Health 2006, 22, 45–49.
Summary
The Eastern stress management techniques derived from the Body-Mind-Spirit (BMS) model by Chan (2001) have been applied to interventions for a variety of clienteles and the effectiveness has been supported by positive psychological outcomes. This study aims to complement these studies by evaluating the efficacy of a one-hour Eastern stress management session in reducing
salivary cortisol levels in working adults in Hong Kong. Pre- and post-test salivary cortisol levels were measured and a significant drop after the session when compared with local normative data was evident. The efficacy of the stress management session, limitations of this study and suggestions for further research are discussed.

Charlton, Bruce G. Despite their inevitable conflicts – Science, religion and New Age spirituality are essentially compatible and complementary activities. Medical Hypotheses 2006, 67, 433–436.
Summary Until recently it seemed that the continued expansion of scientific ways of thinking was destined to render religion extinct and spirituality unfeasible. But the example of the United States disproves this, since America is the most successful scientific nation of this era, church-going remains strong and New Age spiritualities are thriving. Therefore, despite the obvious conflicts; science, religion and spirituality are essentially compatible. Future science will continue
to win territory from religion since its validation procedures are more objective and reliable. However, churches can survive and grow by dropping those aspects of doctrine which clash with science, and expanding their social functions.
The fast-growing US ‘mega-church’ movement shows the way – since these organizations are minimally dogmatic but instead provide a family-orientated and morally-cohesive social milieu. Like organized religion, New Age spirituality comes into conflict with science when it makes incredible or bizarre factual claims. However, in practice modern spirituality is based on subjective evaluations which do not clash with the procedures of science. Indeed, the reliance upon individual, emotion-based evaluations (e.g., ‘my truth’, ‘whatever works for you’) renders New Age spirituality ‘science-proof’, and has enabled it to expand massively in an age of science. Science, religion and spirituality perform different functions in the modern world, and their relationship is therefore one of mutual-dependence. Borderline disputes will inevitably occur, but as part of a broader context of complementary. Science, ‘social’ churches and New
Age spirituality all have a bright future.

Chen, Yung Y./ Koenig, Harold G. Traumatic Stress and Religion: Is there a Relationship? A Review of Empirical Findings. Journal of Religion and Health Fall 2006, 45(3), 371-381.
Abstract: Based on a history of close conceptual link, empirical studies are beginning to accumulate that investigate the relationship between trauma and religion. A review of empirical studies that examined the relationship between religion/spirituality and PTSD showed mixed findings (n = 11). Though the direction of association varied among studies, all but one study reported significant associations between the two. Factors that might have contributed to the mixed findings are discussed (e.g., measurements, research design). Overall, these results appear to be encouraging toward confirming the conceptual link between religion and trauma. Further research investigating the direction of causation and possible moderators of the association may contribute to a better understanding of the relationship between trauma and religion.

Cohen-Katz, Joanne. Mindfulness-Based Stress Reduction and Family Systems Medicine: A Natural Fit. Families, Systems & Health 2004, 22(2), 204-206.
Mindfulness-based stress reduction (MBSR) is a patient-centered treatment modality that is congruent with the core values of family systems medicine. It has numerous applications in clinical and nonclinical settings, including the education of physicians. The article by A.M. Tacon, Y.M. Caldera, and C. Ronaghan (2004) adds to the growing literature base on MBSR by studying its impact on health locus of control in women with breast cancer.

Davies, M. Eshelman, E. et al. The Relaxation & Stress Reduction Workbook, California: New Harbinger 1988

Dethlefson, Thorwald and Dahlke, Rudiger, The Healing Power of Illness: The Meaning of Symptoms and How toInterpret Them, Longmead, UK: Element 1990 (Orig. German 1983). Profoundly insightful book on comprehensive holistic views

Ellard, D.R./ Barlow, J.H./ Mian, R./ Patel, R. Perceived stress, psychological well - being and the activity of neutrophils in patients undergoing cardiopulmonary bypass surgery. Stress and Health 2006, 22, 143–152.
Summary
This study explored relationships, before and after surgery, between perceived stress and the activity of white-blood cells (neutrophils) in 82 patients undergoing heart surgery involving cardiopulmonary bypass surgery (CPB). On the evening before surgery and at follow-up, 6-weeks after discharge, patients completed self-administered standard psychological measures. Small peripheral blood samples were taken, from which neutrophil activity was quantified using nitro-blue tetrazolium (NBT) and luminoldependant chemiluminescence (phagocytic capacity). There were consistent, statistically significant associations between stress and percentageNBT cells at baseline and at follow-up. Regression analysis showed that perceived stress was a predictor of neutrophil activity at follow-up suggesting that higher levels of stress are associated with higher levels of activity. Results from the phagocytic capacity data support and strengthen the NBT findings; in response to stimuli the phagocytic capacity of the neutrophils is reduced at baseline (high stress) and increased at follow-up (lower stress). Significant decreases were found on perceived stress, anxiety, depression, negative affect and health-related stress at follow-up. Patients’ self-efficacy was high at baseline and remained high throughout the study. Results highlighted a consistent, significant relationship between perceived stress and the ‘activity’ of neutrophils. The implications of this finding are worthy of exploration given that stressactivated neutrophils may adversely influence health outcomes.

Fernández, Concepción/ Amigo, Isaac. Efficacy of training in stress and contingency management in cases of irritable bowel syndrome. Stress and Health 2006, 22, 285–295.
Summary
Forty patients with irritable bowel syndrome were assigned at random to four treatment conditions (two experimental groups: training in stress management and training in contingency management; and two control groups: medical treatment and placebo). In each of the groups (N = 10), care was taken to ensure that half the cases were suitable for training in stress management due to the respondent nature of the illness in these cases and the other half suitable for training in contingency management due to the operant nature of their problem. The patients underwent six individual sessions of specific treatment according to the condition. All of the subjects completed symptom-monitoring diaries. In the post-treatment, a MANOVA of mixed factorial design was carried out to analyse the interaction between the suitability of the patient and the type of treatment for the global value of the symptomatology and for each symptom. The results showed that statistically significant changes occurred depending on the interaction between suitability treatment p < 0.1) and on the type of treatment (p < 0.05). The clinical changes recorded by the gastroenterologist were maintained after a year. An analysis is made of the behavioural predictors of the resolution of the patients according to suitability and the type of treatment.

Follette, Victoria/ Palm, Kathleen M./ Pearson. Adria N. Mindfulness and Trauma: Implications for Treatment. Journal of Rational-Emotive & Cognitive-Behavior Therapy Spring 2006, 24(1), 45-61.
Abstract: Mindfulness, originally a construct used in Eastern spiritual and philosophical traditions, has found new utility in psychotherapy practice.
Mindfulness practice has been recently applied to treatments of several psychological and health related problems, and research is showing successful outcomes in psychological interventions incorporating mindfulness practices. Several schools of psychotherapy have theorized why mindfulness may be an effective intervention. One population which would theoretically be benefited by mindfulness practice in treatment consists of those individuals who have
experienced traumatic events and are exhibiting post-traumatic stress disorder and/or related correlates of past trauma. The present paper gives a general review of the application of mindfulness to clinical psychology interventions. Additionally, we explain how mindfulness is applicable to our integrative behavioral approach to treating trauma and its sequelae.
Specifically, this paper will (a) give a general overview of the conceptions and applications of mindfulness to psychology and psychotherapy and provide a brief account of the concepts origins in eastern traditions; (b) discuss the theoretical conceptualization of clinical problems that may relate to the longterm correlates of trauma; (c) describe how mindfulness, acceptance and the therapeutic relationship can address trauma symptoms and discuss a modified treatment approach for trauma survivors that incorporates mindfulness and acceptance practices into traditional exposure treatment.

Green, Elmer and Green, Alyce, Beyond Biofeedback, New York: Delta/Dell 1977. Exceptional book, with excellent basics in biofeedback. Takes the mind-body connection into the spiritual.

Hansen, Ase Marie/ Hogh, Annie/ Persson, Roger/ Karlson, BjÖrn/ Garde, Anne Helene/ Ørbæk, Palle. Bullying at work, health outcomes, and physiological stress response. Journal of Psychosomatic Research 2006, 60, 63– 72.
Abstract
The relationships among bullying or witnessing bullying at work, self-reported health symptoms, and physiological stress reactivity were analysed in a sample of 437 employees (294 women and 143 men). Physiological stress reactivity was measured as cortisol in the saliva. Of the respondents, 5% of the women (n=15) and 5% of the men (n=7) reported bullying, whereas 9% of the women (n=25) and 11% of the men (n=15) had witnessed bullying at work. The results indicated that the bullied respondents had lower social support from coworkers and supervisors, and they reported more symptoms of somatisation, depression, anxiety, and negative affectivity (NA) than did the nonbullied respondents. Witnesses reported more symptoms of anxiety and lower support from supervisor than did the nonbullied employees. Concentrations of cortisol in the saliva were lower at awakening in bullied respondents compared with nonbullied respondents. Previous studies have reported lower diurnal concentration of cortisol for people with posttraumatic stress disorder (PTSD) and chronic fatigue. To our knowledge, this is the first full study on the associations among being subjected to bullying, health outcomes, and physiological stress response.

Hansen, Wilburn. Special Section: Spirituality/Medicine Interface Project Eye on Religion—Shinto and the Japanese Attitude toward Healing. Southern Medical Journal Jan 2007, 100(1), 118-119.

Harrison, John, Love Your Disease - It's Keeping You Healthy, London: Angus and Robertson 1984. Excellent for self-help.

Hay, Louise L., You Can Heal Your Life, Santa Monica, CA: Hay House 1984. Excellent for self-help. Has list of symptoms' meanings and affirmations to counter them.

Holden, R. Laughter, The Best Medicine, Thorsons

Hopper, James W./ Spinazzola, Joseph/ Simpson, William B./ van der Kolk, Bessel A. Preliminary evidence of parasympathetic influence on basal heart rate in posttraumatic stress disorder. Journal of Psychosomatic Research 2006, 60, 83– 90.
Abstract
Objective: Evidence of elevated basal heart rate (HR) in posttraumatic stress disorder (PTSD) has been interpreted in terms of elevated sympathetic cardiac activity, as have possible increased cardiovascular disease risks and outcomes associated with elevated HR. Yet it is well-established that the parasympathetic branch of the autonomic nervous system not only influences HR independently of the sympathetic branch, but makes a greater contribution to HR, including resting HR. Additionally, abnormally low tonic parasympathetic activity on the heart has been implicated in cardiovascular disease and hypertension. This study addressed a potential parasympathetic contribution to elevated basal HR in PTSD.
Methods: We used a descriptive and subgroup differences approach to investigate relationships between parasympathetic activity and basal HR in 59 adults (50 females) with PTSD, all of whom were participants in a treatment outcome study and assessed prior to exposure to trauma-related script-driven imagery. Consistent with the well-known relationship between parasympathetic activity and HR, we hypothesized that basal respiratory sinus arrhythmia (RSA), a measure of parasympathetic cardiac activity, would be negatively correlated with basal HR. More important, we predicted that pathologically elevated HRs previously associated with PTSD would only characterize a low-RSA subgroup. Potential confounds of age, respiration rate, and aerobic fitness were addressed. Results: As predicted, mean HR was 80.5 bpm in the low-RSA tercile group, similar to mean HRs of PTSD groups in prior research and significantly higher than 69 and 65 bpm in the middle- and high- RSA groups, respectively, which are typical of non-PTSD controls.
Conclusion: These findings suggest that a substantial proportion of those with PTSD may not have elevated basal HRs. Furthermore, among those who do exhibit elevated HR, there may be a parasympathetic contribution that is independent of any sympathetic one. Only measuring both branches at once, ideally with autonomic blockades, can definitively address these issues.

Hutch, Richard. Dominance Hierarchies and Health: Constructing Personal Zones of Spiritual Power and Healing in Modern Medicine. Journal of Religion and Health Fall 2006, 45(3), 328-344.
Abstract: Ethological studies of animals in groups and sociobiology indicate that hierarchies of dominance amongst some species ensure the survival of the group. When transferred to human groups, dominance hierarchies suggest a crucial role played by recasting the scope of such hierarchies of dominant and subordinate members to included ‘‘hyper-dominant beings.’’ A recognition of such beings as even more dominant than the socially dominant members of a hierarchy facilitates the empowerment of the socially subordinate members. Religious belief and practice works to establish such hyper-dominant beings (‘‘gods,’’ ‘‘goddesses,’’ and so forth) as superior members of human groups. Doing so is a means of ensuring the survival of the species and, thus, enhancing healing and human health. The ‘‘doctor–patient’’ relationship is examined from such a point of view, with an emphasis on whether the hierarchy created by the relationship allows consideration of alternative and complementary forms of medical treatment.

Hylton Rushton, Cynda. Defining and Addressing Moral Distress Tools for Critical Care Nursing Leaders. AACN Advanced Critical Care 2006, 17(2), 161–168.
Abstract
Nurse clinicians may experience moral distress when they are unable to translate their moral choices into moral action. The costs of unrelieved moral distress are high; ultimately, as with all unresolved professional conflicts, the quality of patient care suffers. As a systematic process for change, this article offers the AACN’s Model to Rise Above Moral Distress, describing four A’s: ask, affirm, assess, and act. To help critical care nurses working to address moral distress, the article identifies 11 action steps they can take to develop an ethical practice environment.

Ishida, Riichiro/ Okada, Masahiko. Effects of a firm purpose in life on anxiety and sympathetic nervous activity caused by emotional stress: assessment by psycho - physiological method. Stress and Health 2006, 22, 275–281.
Summary
Purpose: The concept of purpose in life (PIL) has been explained using such words as ‘existentialism’ or ‘meaning in life’. Crumbaugh and Maholic devised a method to quantitatively measure the meaning in life called the PIL test. To clarify the effect of emotional stress on health, the effects of PIL on anxiety and sympathetic nervous activity caused by emotional stress were assessed. Also the relationship between experiences in life and PIL in adults were examined.
Methods: Thirty-two healthy male and female adult volunteers were recruited for this study. The subjects were required to fill out the PIL test, the manifest anxiety scale (MAS) test, the Cornell Medical Index (CMI) test for sychiatric/somatic symptoms, and the Youth and Adulthood Experiences Inventory (YAEI). Autonomic nervous activity was assessed by measuring heart rate variability before and while watching a video of a roller coaster.
Results: Scores on the PIL test were negatively correlated with scores on the MAS and CMI test for psychiatric/somatic symptoms. PIL scores were positively correlated with the positive experiences of the YAEI. Heart rate measurements of those classed in the infirm purpose in life (IFPIL) group, taken before and while watching the video, showed significant increases in the coefficient of variance (CV), low frequency power (LF), and the difference between low frequency power and high frequency power (LF-HF). The IFPIL heart rate measurements taken while watching the video also showed decreases in high frequency power (HF).
Conclusion: Firm purpose in life (FPIL), which develops by positive experiences in youth and adulthood, contributes to reducing the development of anxiety and relieving the excessive response of the autonomic nervous system to emotional stress.

Isyonov, Eugene V./ Calamari, John E. Does Stress Perception Mediate The Relationship Between Anxiety Sensitivity and Anxiety and Depression Symptoms? Anxiety, Stress, & Coping June 2004, 17(2), 153-162.
Anxiety sensitivity (AS), the fear of anxiety-related symptoms, is strongly implicated in the development of anxiety disorders and is associated with other types of psychopathology. Little is known, though, about the processes through which AS might precipitate distress. As a preliminary step in understanding mechanisms, the mediational role of stress perception was evaluated in a nonclinical sample using a cross sectional design. We conducted a comparison between trait anxiety (TA) and AS to test whether any observed relations were specific to fear of anxiety (AS) or whether associations could be explained by the more general construct. Perceived stress mediated the relation between AS, and specific AS components, and panic symptoms and depression; but not in analyses where TA was statistically controlled. Perceived stress was not found to mediate the relation between TA and panic symptoms or depression, although TA, perceived stress and depression were highly correlated. Although incremental validity was not demonstrated in the present study, stress perception may be an important process through which AS amplifies reactivity to demanding life circumstances and further study is warranted.

Kiecolt-Glaser, Janice K. Norman Cousins Memorial Lecture 1998 Stress, Personal Relationships, and Immune Function: Health Implications. Brain, Behavior, and Immunity 1999, 13, 61–72.
Introduction
The invitation to present the Norman Cousins Memorial Lecture to the Psychoneuroimmunology Research Society is a distinct honor; this recognition is clearly shared by my primary collaborator, Ronald Glaser, who has had equal responsibility for the design of our studies and whose laboratory generated most of the immunological data I will describe. We have addressed a number of questions since we initiated our joint research program in 1982: How do commonplace, everyday stressors affect the immune response? What are the health consequences of stress-related immunological changes? Does a chronic stressor promote persistent immunological dysregulation? Does age pose an additional risk factor? I will address each of these topics briefly; however, as a clinical psychologist, the studies of greatest interest to me are those that have examined the links between close personal relationships and immune responses and, in turn, how these elements are translated into important health outcomes. Thus, these issues will be my primary focus.

Kleber, Herbert D. Commentary on: Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance by Griffiths et al. Psychopharmacology 2006, 187, 291–292.

Koh, Kyung Bong/ Choe, Euiheon/ Song, Jung Eun/ Lee, Eun Ha. Effect of coping on endocrinoimmune functions in different stress situations. Psychiatry Research 2006, 143, 223– 234.
Abstract
The objective of this study was to examine the effects of coping strategies on the endocrine and immune functions in different stress situations. Thirty-eight medical students were enrolled in this study. Cell-mediated immune function was measured using the lymphocyte proliferative response to phytohemagglutinin (PHA) and interleukin-2 (IL-2) production during the nonexamination period and during the preexamination period. Endocrine functions were assessed by measuring the plasma levels of norepinephrine, adrenocorticotropic hormone (ACTH) and cortisol. The Global Assessment of Recent Stress (GARS) scale, the Stress Response Inventory, the anxiety, depression, and somatization subscales of the Symptom Checklist-90-revised, the Way of Coping-revised, the Toronto Alexithymia Scale and the Anger Expression Scale were used as psychometric measures. The subjects with higher levels of total GARS scores showed significantly higher IL-2 production during the nonexam period than those with lower levels of total GARS scores. During the same period, IL-2 production in the less positive reappraisal group was significantly higher than in the more positive reappraisal group. Lymphocyte proliferation in the group seeking less social support was also significantly higher than in the group seeking more social support. However, no significant association was found between the coping strategies and each of the hormone levels. These results suggest that positive reappraisal and seeking social support can be associated with the alteration of immune function during a chronic stress period. In particular, positive reappraisal is likely to reverse the stress-induced immune responses. This study did not find that neuroendocrine function such as the sympathetic-adrenal medullary axis or the hypothalamic–pituitary–adrenal axis is playing a mediating role in the relationship between coping and immunity.

Levine, Stephen, Who Dies? An Investigation of Conscious Living and Conscious Dying, Bath: Gateway 1986 Includes meditations for severe pain. Helpful to people with life-threatening illness

Levine, Stephen, Meetings at the Edge: Dialogues with the Grieving and the Dying, the Healing and the Healed, London & New York: Anchor/Doubleday 1984 Excellent on bereavement counselling

Lewis/ Jordana/ Adler/ Jerry. Forgive and Let Live, Newsweek 9/27/2004, 144(13), 52.

Liebregts, Tobias/ Adam, Birgit/ Bertel, Anton/ Lackner, Carolin/ Neumann, Jens/ Talley, Nicholas J./ Gerken, Guido/ Holtmann, Gerald. Psychological stress and the severity of post-inflamatory visceral hyperalgesia. European Journal of Pain 2007, 11, 216–222.
Abstract
Objectives: Lowered visceral sensory thresholds are a key finding in at least a subgroup of patients with functional bowel disorders. Stress and inflammation contribute to this altered visceral sensory function. We aimed to elucidate the role of repetitive stress and acute mucosal inflammation, alone and in combination, on sensory function.
Methods: In randomized order, trinitrobenzenesulfonic acid (TNBS) plus the equal amount of ethanol or saline were instilled into the colorectum of female Lewis rats. Colorectal distensions (CRD) were performed with a barostat device (3 min/40 mmHg); to quantify the visceromotor response (VMR) to CRD, electromyographic activity (EMG) of the abdominal muscles was recorded.
In randomized order, equal numbers of both treatment groups underwent either seven days (1 h/day) repetitive water avoidance stress (WAS) or sham WAS. CRD’s were conducted 28 days later. Colonic tissue samples were obtained to characterize inflammation and blood samples were taken at day 28 to measure plasma IL-2 levels by enzyme-linked immunosorbent assay (ELISA).
Results: Compared to controls (662 ± 114 lV) TNBS (1081 ± 227 lV), WAS (1366 ± 125 lV) and the combination of both (1477 ± 390 lV) significantly augmented the VMR to CRD. TNBS and/or WAS caused significant inflammatory changes at day 5, while only TNBS + WAS also showed signs of mucosal inflammation on day 14 and significantly elevated IL-2 levels on day 28.
Conclusions: Stress and inflammation cause long lasting alterations of visceral sensory function. Concomitant stress further increases post-inflammatory visceral hyperalgesia.

Lovett, Richard A. Escape Getting Away From It All (Even If You Can’t Go Far). Psychology Today July/Aug 2004, 54-60.

Lucini, Daniela/ Di Fede, Gaetana/ Parati, Gianfranco/ Pagani, Massimo. Impact of Chronic Psychosocial Stress on Autonomic Cardiovascular Regulation in Otherwise Healthy Subjects. Hypertension 2005, 46, 1201-1206.
Abstract—Elevated psychosocial stress might favor the occurrence of cardiovascular disease; however, mechanisms are incompletely understood. We hypothesized that patients (n=126; 44±1 years of age) referred to an internal medicine clinic because of symptoms related to chronic psychosocial stress would demonstrate signs of autonomic dysregulation compared with controls (n=132; 42±1 years of age). We used autoregressive spectral analysis of RR interval variability to obtain indirect markers of sympathetic and of vagal (respectively, low-frequency and high-frequency components, both expressed in normalized units) oscillatory modulation of sinoatrial node, as well as of sympathetic vasomotor regulation (low-frequency component of systolic arterial pressure variability) and of cardiac baroreflex sensitivity (α-index). Higher values of systolic and diastolic arterial pressure (respectively, 124±1 versus 117±1 mmHg and 80±1 versus 75±1 mm Hg; both P<0.001), altered markers of autonomic regulation (increased normalized low-frequency and reduced high-frequency component of RR variability, P_0.005; increased-low frequency component of systolic arterial pressure variability, P<0.002), and reduced baroreflex sensitivity (19.3±1.4 versus 23.0±2.0 ms/mm Hg; P<0.05) were observed in patients compared with controls. Autonomic responses to active standing were also blunted in stressed patients. Autonomic markers were significantly correlated to stress perception score and were capable of discriminating between controls and patients with a high degree of accuracy. Chronic real-life stress in humans appears associated to increased arterial pressure and to impaired autonomic regulation of cardiovascular functions. The combination of sympathetic predominance, vagal withdrawal, and blunted baroreflex sensitivity might represent a treatable mechanistic link between psychosocial factors and future incidence of hypertension.

Lyon, Debra E./ Younger, Janet. Development and Preliminary Evaluation of the Existential Meaning Scale. Journal of Holistic Nursing Mar 2005, 23(1), 54-65.
Purpose: The aim of this study was to develop and examine the psychometric properties of the Existential Meaning Scale (EMS).
Findings: Construct validity of the EMS was examined through factor analysis and correlational analyses with theoretically related instruments. After several weak items were deleted, the 20-item scale had a Cronbach’s alpha coefficient of > .80 in an overall sample of 418 individuals. Scores on theEMSwere significantly lower in a sample of persons with HIV-1 infection than in the general population samples.
Conclusion: Although its initial psychometric properties were satisfactory, additional validation of the EMS is necessary in other clinical populations to examine further the psychometric properties of the EMS. In addition, further examination of the responsiveness of the EMS over time is needed to
evaluate its potential utility in longitudinal trials.

Lyvers, Michael/ Barling, Norman/ Harding-Clark, Jill. Effect of belief in “psychic healing” on self-reported pain in chronic pain sufferers. Journal of Psychosomatic Research 2006, 60, 59– 61.
Abstract
Objective: The “psychic healing” ability of a well-known Australian psychic was subjected to a televised experimental test.
Methods: Twenty volunteers suffering from chronic pain were recruited by newspaper advertisements. Half were randomly assigned to the treatment or control condition using a double-blind procedure.
Results: Comparison of pre- and posttreatment McGill Pain Questionnaire ratings indicated no effect of psychic healing. However, pretreatment questionnaire ratings of belief in psychic healing and related phenomena were significantly correlated with improvement in McGill Pain Questionnaire ratings irrespective of treatment condition.
Conclusion: Results suggest that anecdotal reports of effective psychic healing and “faith healing” are attributable to the power of belief.

Miller, Gregory E./ Chen, Edith/ Zhou, Eric S. If It Goes Up, Must It Come Down? Chronic Stress and the Hypothalamic-Pituitary-Adrenocortical Axis in Humans. Psychological Bulletin 2007, 133(1), 25–45.
The notion that chronic stress fosters disease by activating the hypothalamic-pituitary-adrenocortical (HPA) axis is featured prominently in many theories. The research linking chronic stress and HPA function is contradictory, however, with some studies reporting increased activation, and others reporting the opposite. This meta-analysis showed that much of the variability is attributable to stressor and person features. Timing is an especially critical element, as hormonal activity is elevated at stressor onset but reduces as time passes. Stressors that threaten physical integrity, involve trauma, and are uncontrollable elicit a high, flat diurnal profile of cortisol secretion. Finally, HPA activity is shaped by a person’s response to the situation; it increases with subjective distress but is lower in persons with posttraumatic stress disorder.

Nichols, David E. Commentary on: Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance by Griffiths et al. Psychopharmacology 2006, 187, 284–286.

Oman, Doug/ Hedberg, John/ Thoresen, Carl E.  Passage Meditation Reduces Perceived Stress in Health Professionals: A Randomized, Controlled Trial. Journal of Consulting and Clinical Psychology 2006, 74(4), 714–719.
The authors evaluated an 8-week, 2-hr per week training for physicians, nurses, chaplains, and other health professionals using nonsectarian, spiritually based self-management tools based on passage meditation (E. Easwaran, 1978/1991). Participants were randomized to intervention (n = 27) or waiting list (n = 31). Pretest, posttest, and 8- and 19-week follow-up data were gathered on 8 measures, including perceived stress, burnout, mental health, and psychological well-being. Aggregated across examinations, beneficial treatment effects were observed on stress ( p = .0013) and mental health ( p = .03). Treatment effects on stress were mediated by adherence to practices ( p < .05). Stress reductions remained large at 19 weeks (84% of the pretest standard deviation, p = .006). Evidence suggests this program reduces stress and may enhance mental health.

Rosenthal, R and Rubin, DB Interpersonal expectancy effects: the first 345 studies, Behavior and Brain Sciences, 1978, 3, 377-415. Clinical suggestion, including suggestion within research studies

Rushton, Cynda Hylton. Defining and Addressing Moral Distress Tools for Critical Care Nursing Leaders. AACN Advanced Critical Care 2006, 17(2), 161–168.
Nurse clinicians may experience moral distress when they are unable to translate their moral choices into moral action. The costs of unrelieved moral distress are high; ultimately, as with all unresolved professional conflicts, the quality of patient care suffers. As a systematic process for change, this article offers the AACN’s Model to Rise Above Moral Distress, describing four A’s: ask, affirm, assess, and act. To help critical care nurses working to address moral distress, the article
identifies 11 action steps they can take to develop an ethical practice environment.

Salick, Elizabeth C./ Auerbach, Carl F.  From Devastation to Integration: Adjusting to and Growing From Medical Trauma. Qualitative Health Research Oct 2006, 16(8), 1021-1037.
Recent trauma research has begun to investigate the possibility of posttraumatic growth. However, most studies have investigated posttraumatic growth using quantitative methods and thus have neglected people’s subjective experience and have left unexamined posttraumatic growth in persons with visible impairment. To fill some of these gaps, the authors examined the process of recovery and posttraumatic growth using a qualitative method. They interviewed 10 participants with visible impairment from chronic illness or serious injury using a semistructured interview. Using a grounded theory data analysis procedure, the authors developed a stage model of trauma and recovery from the interviews.
The stages that emerged are thematically entitled Apprehension, Diagnosis and Devastation, Choosing to Go On, Building a Way to Live, and Integration of the Trauma and Expansion of the Self. The authors discuss limitations of the study and clinical implications for psychological counseling with this population.

Schubert, Christian/ Noisternig, Bianca/ Fuchs, Dietmar/ König, Paul/ Chamson, Emil/ Mittnik, Stefan/ Schüßler, Gerhard/ Geser, Willi. Multi - faceted effects of positive incidents on stress system functioning in a patient with systemic lupus erythematosus. Stress and Health 2006, 22, 215–227.
Summary
This study on a patient with systemic lupus erythematosus (SLE) investigated the impact of positive emotionally pleasing incidents on hypothalamus-pituitary-adrenal (HPA) axis and cellular immune system activity under complex everyday conditions. A 52 year-old woman collected her entire urine for 56 days in 12-h intervals for the determination of cortisol and neopterin, a cellular immune parameter. Psychological variables were based on daily questionnaires and weekly interviews. Time series analysis consisted of ARIMA modeling and cross-correlational analysis. Positive everyday incidents were associated with three distinct emotional reactions: short-term positive reactions, anticipatory negative reactions, and long-term negative reactions. Short-term positive reactions were associated with a decrease in urine cortisol after 36 h and an increase after a total of 48 h, while urine neopterin increased 24 h after the incidents and decreased after a total of 84 h. Anticipatory negative reactions were associated with an initial increase in urine cortisol 24h before the incident occurred and with a subsequent decrease a total of 12 h following the incident. Long-term negative reactions were associated with an ultimate increase in urine neopterin 144h after the incidents. These findings empirically demonstrate that one specific category of positive everyday incidents can be associated with multiple emotional reactions that differ in valence (positive/negative) and duration (short-term/long-term), and also depend on whether an incident was expected (anticipated/not anticipated). This calls for a careful categorization of positive incidents when testing stress system functioning under complex everyday life conditions.

Schuster, Charles R. Commentary on: Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance by Griffiths et al. Psychopharmacology 2006, 187, 289–290.

Shapiro, Francine, Eye Movement Desensitization and Reprocessing, New York: Guildford 1995. Outstanding method of stress reduction with post-traumatic stress disorders, phobias, and many other stress related problems.

Sideridis, Georgios D. Coping is not an ‘either’ ‘or’: the interaction of coping strategies in regulating affect, arousal and performance. Stress and Health 2006, 22, 315–327.
Summary
The purpose of the present studies was to (a) examine the association between coping, affect, and stress during demanding, stressful tasks, and (b) examine the presence of a synergy between coping strategies towards regulating stress, affect and performance. In Study 1 participants were 53 first year undergraduate students at a state university. Student’s coping strategies were assessed prior to a job interview. Results indicated that emotion-focused coping was associated with significantly elevated negative affect compared to problem-focused coping. Inclusion of an interaction term reflecting different levels of the two coping strategies showed enhanced adaptation compared to the use of either problem-focused or emotion-focused coping strategies. Study 2 aimed at replicating the findings of Study 1, and extend them with assessment of behavioral and physiological indices of stress. Participants were 48 undergraduate students and their coping, affect, and behavioral and physiological stress were assessed prior to an in-class presentation. Results indicated that neither problem nor emotion-focused coping were associated with stress levels. However, the interaction of problem-focused and emotion-focused strategies was associated with significantly lessened stress. It is concluded that the presence of more than one coping strategy at a given time may be more adaptive compared to the adoption of one type of strategy.

Slife, Brent D./ Nelson, James M. Conclusion: Implications for the Psychology of Religion. Journal of Psychology and Theology 2006, 34(3), 289-291.

Snyder, Solomon H. Commentary on: Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance by Griffiths et al. Psychopharmacology 2006, 187, 287–288.

Stanley, Robb O./ Burrows, Graham D.  Editorial It is now the time to further help the professionals and the public understand the nature, role and implications of stress for ill – health. Stress and Health 2006, 22, 139–141.

Steadman, A. Who's the Matter with Me? Marina del Rey, CA: DeVorss 1966   Excellent for self-help

Sutcliffe, J. The Complete Book of Relaxation Techniques, People's Medical Society Book 1991

Thune´ -Boyle, Ingela C./ Stygall, Jan A./ Keshtgar, Mohammed R./
Newman, Stanton P. Do religious/spiritual coping strategies affect illness adjustment in patients with cancer? A systematic review of the literature. Social Science & Medicine 2006, 63, 151–164.
Abstract
The present paper systematically reviews studies examining the potential beneficial or harmful effects of religious/spiritual coping with cancer. Using religion and spirituality as resources in coping may be specifically prevalent in patients with cancer considering the potentially life-threatening nature of the illness. Religious/spiritual coping may also serve multiple functions in long-term adjustment to cancer such as maintaining self-esteem, providing a sense of meaning and purpose, giving emotional comfort and providing a sense of hope. Seventeen papers met the inclusion criteria of which seven found some evidence for the beneficial effect of religious coping, but one of these also found religious coping to be detrimental in a sub-sample of their population. A further three studies found religious coping to be harmful and seven found non-significant results. However, many studies suffered from serious methodological problems, especially in the manner in which religious coping was conceptualised and measured. The studies also failed to control for possible influential variables such as stage of illness and perceived social support. Due to this, any form conclusions about the possible beneficial or harmful effects of religious coping with cancer is lacking. These problems are discussed and suggestions for future studies are made.

Trief, Paula M./ Ouimette, Paige/ Wade, Michael/ Shanahan, Paul/ Weinstock, Ruth S. Post-traumatic Stress Disorder and Diabetes: Co-Morbidity and Outcomes in a Male Veterans Sample. Journal of Behavioral Medicine Oct 2006, 29(5), 411-418.
The purpose of this study was to assess the prevalence and correlates of comorbid diabetes and Post-Traumatic Stress disorder(PTSD)and potential relationships between PTSD and diabetes outcomes. Male patients enrolled in a VA primary care database (N = 73,270) were classified as having diabetes from pharmacy records (N = 14,438) and grouped into those with diagnoses of PTSD with depression (N = 649), PTSD-only (N = 480), Depression-only (N = 1696),Other psychiatric diagnosis (N = 736), or No psychiatric diagnosis (N = 10,877) based on the Purpose of Visit diagnoses in the medical record. Outcomes included glycemic control (HbA1c), cholesterol and tryglycerides. Correlates were age, substance use disorder, other psychiatric diagnosis, number of primary care encounters, and medications. The prevalence of comorbid diabetes and PTSD was 8% (n = 1129). Of these, 57% (n = 649) had comorbid depression. Patients with PTSD and depression had higher rates of substance use disorder and higher cholesterol and LDL. Patients with depression had poorer glycemic control. Patients with PTSD and depression weighed more and had higher BMI than patients with neither diagnosis. Thus, male diabetes patients with PTSD and depression may be vulnerable to substance use disorders and to weight/lipid problems that can affect health. Depression is a likely contributor to poor glycemic control. Careful screening for mental health comorbidities is needed for diabetes patients.

van Doornen, Lorenz J.P./ Orlebeke, K.F. Stress, Personality and Serum-Cholesterol Level. Journal of Human Stress Dec 1982, 8(4), 24-9.
It appears that serum-cholesterol level may serve as an important mediator between psychological variables and coronary heart disease (CHD). From a review of the literature it is concluded that (1) psychological stressors significantly elevate serum-cholesterol level and (2) psychological characteristics like the Type A-pattern and depression are positively correlated with serum-cholesterol levels. This suggests that the relationship between CHD and stress and coronary prone behavior may be partially explained by the mediating role of serum-cholesterol. A more careful consideration of psychological variables may be helpful in reducing the substantial amount of unexplained variance in cholesterol levels.

Walton, Kenneth G./  Schneider, Robert H./ Salerno, John W./ Nidich, Sanford I. Psychosocial Stress and Cardiovascular Disease Part 3: Clinical and Policy Implications of Research on the Transcendental Meditation Program. Behavioral Medicine Winter 2005, 30, 173-183.
Cardiovascular disease (CVD) remains the leading cause of death in the United States today and a major contributor to total health care costs. Psychosocial stress has been implicated in CVD, and psychosocial approaches to primary and secondary prevention are gaining research support. This third article in the series on psychosocial stress and CVD continues the evaluation of one such approach, the Maharishi Transcendental Meditation® program, a psychophysiological approach from the Vedic tradition that is systematically taught by qualified teachers throughout the world. Evidence suggests not only that this program can provide benefits in prevention but also that it may reduce CVD-related and other health care expenses. On the basis of data from the studies available to date, the Transcendental Meditation program may be responsible for reductions of 80% or greater in medical insurance claims and payments to physicians. This article evaluates the implications of research on the Transcendental Meditation program for health care policy and for largescale clinical implementation of the program. The Transcendental Meditation program can be used by individuals of any ethnic or cultural background, and compliance with the practice regimen is generally high. The main steps necessary for wider adoption appear to be: (1) educating health care providers and patients about the nature and expected benefits of the program, and (2) adjustments in public policies at the state and national levels to allow this program to be included in private and public health insurance plans.

Zapka, Jane/ Fisher, Gene/ Lemon, Stephanie/ Clemow, Llynn/ Fletcher, Kenneth. Relationship and Distress in Relatives of Breast Cancer Patients. Families, Systems, & Health 2006, 24(2), 198–212.
This study examines the association of relationship factors with distress among first-degree female relatives (FDFRs; n = 540) of newly diagnosed breast cancer patients (n = 306). Cancer factors (receiving chemotherapy, positive nodes) and relationship factors (more contact, greater emotional closeness, and being told the diagnosis by the patient) were related to greater perceived impact of the cancer on the patient. Several of these factors, as well as FDFR factors (younger age, minority status, higher risk perception) and relationship factors (being the mother or daughter of the patient), were significantly related to the FDFR’s cancer-specific distress, general distress, or both. Notably, the FDFR’s own social support was associated with both cancerspecific and general distress. Appreciating the impact of a relative’s cancer on FDFRs and offering guidance and support via patient- centered counseling can enhance quality of care.