Publications by authors named "Jeanette M Bennett"

27 Publications

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Mental health is the health of the whole body: How psychoneuroimmunology & health psychology can inform & improve treatment.

J Eval Clin Pract 2020 Oct 14;26(5):1539-1547. Epub 2020 Mar 14.

Health Psychology PhD Program, UNC Charlotte, Charlotte, North Carolina, USA.

Background: Converging and accumulating evidence for the cross-communication among the nervous, immune, and endocrine systems, a field of study known as psychoneuroimmunology, implicates immunological dysfunction as a shared and common mechanism of both mental and physical illness. For example, psychiatric disorders like schizophrenia, bipolar disorder, major depression, and anxiety disorders have higher prevalence rates across a spectrum of autoimmune conditions compared to the general population. Additionally, subclinical immunological abnormalities are observed in a variety of psychiatric conditions, with chronic inflammation most extensively studied in the pathophysiology of depression. These observations blur the historical distinctions between mental and physical illness, yet clinical practice remains fragmented and primarily focused on differentially treating individual symptoms.

Proposed Thesis: Therapeutically targeting inflammation offers translational opportunities for integrating mental and physical healthcare, a key niche of the interdisciplinary field of health psychology.

Conclusion: Utilizing a psychoneuroimmunological lens, health psychologists and clinicians can reconceptualize healthcare through integrative treatment approaches and advocacy for comprehensive policy-level reform at both the individual-level of care as well as community-wide prevention approaches.
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http://dx.doi.org/10.1111/jep.13386DOI Listing
October 2020

"Get a Grip on Hypertension": EXPLORING THE USE OF ISOMETRIC HANDGRIP TRAINING IN CARDIOPULMONARY REHABILITATION PATIENTS.

J Cardiopulm Rehabil Prev 2019 11;39(6):E31-E34

Departments of Kinesiology (Drs Gordon, Marino, and Howden and Mss Whitmire and Zacherle), Biological Sciences (Drs Leamy and Reitzel), and Psychological Science (Dr Bennett), UNC Charlotte, North Carolina; Carolinas HealthCare System NorthEast, Concord, North Carolina (Mr Doyle and Dr Gulati); Department of Life and Sports Science, University of Greenwich, London, United Kingdom (Dr Swaine); and Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Pennsylvania (Dr Gordon).

Purpose: Isometric handgrip (IHG) training lowers systolic and diastolic blood pressure (SBP and DBP, respectively), but the efficacy of IHG training in cardiopulmonary rehabilitation patients is unknown. The purpose of this study was to determine if IHG decreases blood pressure in cardiopulmonary rehabilitation patients.

Methods: Cardiopulmonary rehabilitation program participants (n = 11; 50-80 yr old) were randomized to IHG (n = 6) or control (CON; no treatment; n = 5) groups. IHG participants completed an IHG training program at 30% maximal voluntary contraction, 3 d/wk for 6 wk. Resting SBP, DBP, and heart rate were assessed weekly.

Results: Mean regression for SBP following IHG was negative (-1.04 ± 0.80). Mean regression in the CON group was positive (0.50 ± 0.88), but there was no significant difference between groups. Separate analysis of weeks 1 to 7 yielded a negative mean regression (-1.12 ± 0.54) in the IHG group, but positive (1.2 ± 0.60) in the CON group. A Wilcoxon test of these differences yielded significance for SBP (P = .009). In 3 of 6 IHG participants, SBP was lower (mean ± SD: -16 ± 11 mm Hg; P = .12), and in 2 IHG participants, DBP was lower (-9 ± 1 mm Hg; P = .06) compared with baseline. In 2 of 5 CON participants, SBP was not significantly lower (-11 ± 7 mm Hg) and, in 3 of 5 CON participants, DBP was lower (-7 ± 4 mm Hg; P = .04).

Conclusions: Our data suggest that standard IHG training may be inadequate for blood pressure management immediately following a major cardiac or pulmonary event. Future work with a larger cohort and more developed training protocol to determine the efficacy of IHG training in patients with cardiopulmonary disease is warranted.
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http://dx.doi.org/10.1097/HCR.0000000000000468DOI Listing
November 2019

Post-traumatic stress and psychological health following infidelity in unmarried young adults.

Stress Health 2019 Oct 26;35(4):468-479. Epub 2019 Jul 26.

Health Psychology PhD Program, The University of North Carolina at Charlotte, Charlotte, North Carolina.

Infidelity is often conceptualized as a traumatic event; however, little research has explored this topic empirically, particularly in unmarried adults. We determined the prevalence of infidelity-related post-traumatic stress disorder (PTSD) symptoms among unmarried adults who experienced a partner's infidelity and whether probable infidelity-related PTSD was associated with additional psychological health outcomes (i.e., depressive symptoms, perceived stress, and anxiety symptoms). We also investigated whether negative post-traumatic cognitions mediated the associations between infidelity-related PTSD symptoms and psychological health. This study included 73 adults (M age = 19.42, SE = 0.19 years) who experienced infidelity within a committed nonmarital relationship within the last 5 years. Controlling for gender, race, and exposure to Diagnostic and Statistical Manual of Psychiatric Disorders Criterion A traumas, 45.2% of our sample reported symptoms suggesting probable infidelity-related PTSD. Whether used as continuous or categorical predictor, infidelity-related PTSD symptoms were significantly associated with depressive symptoms, although results for perceived stress and anxiety symptoms were mixed. Post-traumatic cognitions acted as a partial mediator for depressive symptoms and full mediator for perceived stress and anxiety symptoms. This empirical evidence suggests that infidelity may produce PTSD symptoms at a relatively high rate, even in unmarried young adults, and may put individuals at risk for poorer psychological health, partially through post-traumatic cognitions.
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http://dx.doi.org/10.1002/smi.2880DOI Listing
October 2019

Health and Disease-Emergent States Resulting From Adaptive Social and Biological Network Interactions.

Front Med (Lausanne) 2019 28;6:59. Epub 2019 Mar 28.

Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands.

Health is an adaptive state unique to each person. This subjective state must be distinguished from the objective state of disease. The experience of health and illness (or poor health) can occur both in the absence and presence of objective disease. Given that the subjective experience of health, as well as the finding of objective disease in the community, follow a Pareto distribution, the following questions arise: What are the processes that allow the emergence of four observable states-(1) subjective health in the absence of objective disease, (2) subjective health in the presence of objective disease, (3) illness in the absence of objective disease, and (4) illness in the presence of objective disease? If we consider each individual as a unique biological system, these four health states must emerge from physiological network structures and personal behaviors. The underlying physiological mechanisms primarily arise from the dynamics of external environmental and internal patho/physiological stimuli, which activate regulatory systems including the hypothalamic-pituitary-adrenal axis and autonomic nervous system. Together with other systems, they enable feedback interactions between all of the person's system domains and impact on his system's entropy. These interactions affect individual behaviors, emotional, and cognitive responses, as well as molecular, cellular, and organ system level functions. This paper explores the hypothesis that health is an emergent state that arises from hierarchical network interactions between a person's external environment and internal physiology. As a result, the concept of health synthesizes available qualitative and quantitative evidence of interdependencies and constraints that indicate its top-down and bottom-up causative mechanisms. Thus, to provide effective care, we must use strategies that combine person-centeredness with the scientific approaches that address the molecular network physiology, which together underpin health and disease. Moreover, we propose that good health can also be promoted by strengthening resilience and self-efficacy at the personal and social level, and via cohesion at the population level. Understanding health as a state that is both individualized and that emerges from multi-scale interdependencies between microlevel physiological mechanisms of health and disease and macrolevel societal domains may provide the basis for a new public discourse for health service and health system redesign.
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http://dx.doi.org/10.3389/fmed.2019.00059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447670PMC
March 2019

Inflammation-Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing "the Epidemic" of Chronic Diseases.

Front Med (Lausanne) 2018 27;5:316. Epub 2018 Nov 27.

School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.

Siloed or singular system approach to disease management is common practice, developing out of traditional medical school education. Textbooks of medicine describe a huge number of discrete diseases, usually in a systematic fashion following headings like etiology, pathology, investigations, differential diagnoses, and management. This approach suggests that the body has a multitude of ways to respond to harmful incidences. However, physiology and systems biology provide evidence that there is a mechanism behind this phenotypical variability. Regardless if an injury or change was caused by trauma, infection, non-communicable disease, autoimmune disorders, or stress, the typical physiological response is: an increase in blood supply to the area, an increase in white cells into the affected tissue, an increase in phagocytic activity to remove the offending agent, followed by a down-regulation of these mechanisms resulting in healing. The is the body's unique mechanism to maintain its integrity in response to macroscopic as well as microscopic injuries. We hypothesize that chronic disease development and progression are linked to uncontrolled or dysfunctional inflammation to injuries regardless of their nature, physical, environmental, or psychological. Thus, we the prevailing approach of management of individual diseases into a more integrated systemic approach of treating the "person as a whole," enhancing the patient experience, ability to a make necessary changes, and maximize overall health and well-being. The first part of the paper reviews the local immune cascades of pro- and anti-inflammatory regulation and the interconnected feedback loops with neural and psychological pathways. The second part emphasizes one of nature's principles at work- and . Continually overwhelming this finely tuned system will result in systemic inflammation allowing chronic diseases to ; the pathways of several common conditions are described in detail. The final part of the paper considers the implications of these understandings for clinical care and explore how this lens could shape the physician-patient encounter and health system redesign. We conclude that healthcare professionals must advocate for an anti-inflammatory lifestyle at the patient level as well as at the local and national levels to enhance population health and well-being.
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http://dx.doi.org/10.3389/fmed.2018.00316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277637PMC
November 2018

Higher trait reappraisal predicts stronger HPA axis habituation to repeated stress.

Psychoneuroendocrinology 2019 03 23;101:12-18. Epub 2018 Oct 23.

Department of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany. Electronic address:

Undergoing stress can be advantageous when it leads to adaptation and growth; however, failure of the hypothalamic-pituitary-adrenal (HPA) axis to habituate (i.e., nonhabituation) involves continuing to become highly activated in response to repeated exposure of the same stimulus and is considered maladaptive. Although 50-75% of individuals assessed in a laboratory exhibit adaptive habituation to repeated stress, variability in habituation suggests psychological processes used in response to stress may play a role, such as emotion regulation (ER). Nonetheless, no research to date has investigated whether ER strategies affect HPA axis habituation. We investigated whether tendency to use two ER strategies, reappraisal and suppression, influenced HPA axis habituation among 84 healthy young adults (60.7% female; M = 24.8 years, SD = 6.0) exposed to a standardized experimental stress paradigm on two consecutive days. HPA axis stress responses were assessed using salivary cortisol concentrations. We also examined whether non-manipulated state ER strategies (i.e., those used by the participant during and following the stressor on the first day) modulated HPA axis habituation over and above trait-use in a subsample (N = 60). Trait, but not state, reappraisal was associated with stronger HPA axis habituation. Neither trait nor state suppression were significantly associated with HPA axis habituation. These findings expand our current understanding of how ER can affect stress-related health outcomes and suggest habitual reappraisal plays an important role in adaption of the HPA axis to stress.
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http://dx.doi.org/10.1016/j.psyneuen.2018.10.018DOI Listing
March 2019

A comparison of blood pressure reductions following 12-weeks of isometric exercise training either in the laboratory or at home.

J Am Soc Hypertens 2018 11 22;12(11):798-808. Epub 2018 Sep 22.

Department of Kinesiology, The University of North Carolina at Charlotte, Charlotte, NC, USA.

Isometric exercise training (IET)-induced reductions in resting blood pressure (RBP) have been achieved in laboratory environments, but data in support of IET outside the laboratory are scarce. The aim of this study was to compare 12 weeks of home-based (HOM) IET with laboratory-based, face-to-face (LAB) IET in hypertensive adults. Twenty-two hypertensive participants (24-60 years) were randomized to three conditions: HOM, LAB, or control (CON). IET involved isometric handgrip training (4 × 2 minutes at 30% maximum voluntary contraction, 3 days per week). RBP was measured every 6 weeks (0, 6, and 12 weeks) during training and 6 weeks after training (18 weeks). Clinically meaningful, but not statistically significant reductions in RBP were observed after 12 weeks of LAB IET (resting systolic blood pressure [SBP] -9.1 ± 4.1; resting diastolic blood pressure [DBP] -2.8 ± 2.1; P > .05), which was sustained for 6 weeks of detraining (SBP -8.2 ± 2.9; DBP -4 ± 2.9, P > .05). RBP was reduced in the HOM group after 12 weeks of training (SBP -9.7 ± 3.4; DBP -2.2 ± 2.0; P > .05), which was sustained for an additional 6 weeks of detraining (SBP -5.5 ± 3.4; DBP -4.6 ± 1.8; P > .05). Unsupervised home-based IET programs present an exciting opportunity for community-based strategies to combat hypertension, but additional work is needed if IET is to be used routinely outside the laboratory.
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http://dx.doi.org/10.1016/j.jash.2018.09.003DOI Listing
November 2018

Biopsychosocial approach to understanding resilience: Stress habituation and where to intervene.

J Eval Clin Pract 2018 Dec 18;24(6):1339-1346. Epub 2018 Oct 18.

School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.

Background: Resilience in the face of adversity is a human experience that leads to better health, both mentally and physically. We briefly review its historical origins rooted in ecological biology and its adoption into health care. Resilience is the common response to adversity or potential traumatic events. Individual differences in emotion regulation and coping skills as well as social capital and one's physical environment influence a person's ability to achieve resilience.

Proposed Mechanism: One potential biopsychosocial measure of resilience includes stress habituation to repeated stress as demonstrated in the laboratory, possibly providing a tool to observe mastery of resilience training in the clinic. Evidence-based interventions at the individual and small group level (eg, family, classroom) have successfully shown development of resilient behaviours and improved mental and physical health outcomes. However, the role of social context and public policy clearly influence an individual's ability to be resilient.

Conclusions: Despite the current limited evidence of the effectiveness of resilience building interventions, clinicians, researchers, and other health care professions have an obligation to become advocates for laws and policies that support the most vulnerable, and least resilient, in our society to attain resilience for their health. This salutary effect will enable them to become socially as well as economically productive members of the community at large. It is not possible to remove stress or adversity from life, but we can influence the development of regulatory flexibility and decrease the sociocultural factors linked to the nonresilient experience, thus mitigating adversity's long-term effects on health.
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http://dx.doi.org/10.1111/jep.13052DOI Listing
December 2018

Stressful life events, relationship stressors, and cortisol reactivity: The moderating role of suppression.

Psychoneuroendocrinology 2018 03 2;89:69-77. Epub 2018 Jan 2.

Health Psychology PhD Program, USA; Department of Psychological Science, The University of North Carolina at Charlotte, USA. Electronic address:

Stressful life events (SLEs) are exceedingly common and have been associated with a range of psychological disorders, perhaps through dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis. The use of certain emotion regulation strategies in response to stress, such as expressive suppression and cognitive reappraisal, has additionally been linked to heightened HPA axis reactivity to acute stress. However, it is unclear how emotion regulation may interact with SLEs to affect HPA axis reactivity, particularly concerning relationship stressors (RSs). Using cross-sectional data from 117 men and 85 women aged 18-55 years old (M = 39.9 ± 10.7), we investigated whether trait use of suppression or reappraisal interacted with recent negatively perceived SLEs and relationship stressors to impact HPA axis response to an acute stressor. Separate area under the curve and linear mixed models revealed that trait suppression interacted with SLEs and RSs to predict cortisol response to stress, while reappraisal did not. Findings indicate higher trait expressive suppression may influence the cortisol response to acute stress after exposure to more recent stressful events, particularly when those stressful events include relationship stress.
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http://dx.doi.org/10.1016/j.psyneuen.2017.12.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878721PMC
March 2018

Inflammation and positive affect: Examining the stress-buffering hypothesis with data from the National Longitudinal Study of Adolescent to Adult Health.

Brain Behav Immun 2017 Mar 18;61:21-26. Epub 2016 Jul 18.

Health Psychology Graduate Program, The University of North Carolina at Charlotte, USA; Department of Psychology, The University of North Carolina at Charlotte, USA. Electronic address:

The present study examined the influence of positive affect (PA) on levels of inflammation within the context of Pressman and Cohen's (2005) stress-buffering model, which suggests that PA confers protective health benefits through its ability to mitigate the pathogenic influence of stress. We hypothesized that greater PA would buffer against the influence of perceived psychological stress (PPS) on systemic inflammation, operationalized as C-reactive protein (CRP, mg/L). Specifically, we predicted that PA would moderate the relationship between PPS and CRP. Cross-sectional data were drawn from Wave IV (2008-2009) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants (n=3093) ranged in age from 25 to 34years old (M=29.0±1.79). Using a moderated hierarchical regression analysis, PPS and PA significantly interacted to predict levels of CRP (p<0.05). Examination of the simple slopes revealed a disordinal interaction between PPS and PA, such that higher PA was protective against elevated CRP levels, but only when individuals also reported greater levels of PPS. Thus, the data partially support the stress-buffering model of PA and extend existing evidence regarding the complexity by which PPS and PA influence health. Findings also provide caution of future assumptions that relationships among PA, PPS, and physical health markers, such as CRP, are always positive (e.g., PA) or negative (e.g., PPS) in nature.
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http://dx.doi.org/10.1016/j.bbi.2016.07.149DOI Listing
March 2017

'Multimorbidity' as the manifestation of network disturbances.

J Eval Clin Pract 2017 Feb 15;23(1):199-208. Epub 2016 Jul 15.

Division of Behavioral Medicine, Department of Psychiatry, Department of Neurology and CTNI, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.

We argue that 'multimorbidity' is the manifestation of interconnected physiological network processes within an individual in his or her socio-cultural environment. Networks include genomic, metabolomic, proteomic, neuroendocrine, immune and mitochondrial bioenergetic elements, as well as social, environmental and health care networks. Stress systems and other physiological mechanisms create feedback loops that integrate and regulate internal networks within the individual. Minor (e.g. daily hassles) and major (e.g. trauma) stressful life experiences perturb internal and social networks resulting in physiological instability with changes ranging from improved resilience to unhealthy adaptation and 'clinical disease'. Understanding 'multimorbidity' as a complex adaptive systems response to biobehavioural and socio-environmental networks is essential. Thus, designing integrative care delivery approaches that more adequately address the underlying disease processes as the manifestation of a state of physiological dysregulation is essential. This framework can shape care delivery approaches to meet the individual's care needs in the context of his or her underlying illness experience. It recognizes 'multimorbidity' and its symptoms as the end product of complex physiological processes, namely, stress activation and mitochondrial energetics, and suggests new opportunities for treatment and prevention. The future of 'multimorbidity' management might become much more discerning by combining the balancing of physiological dysregulation with targeted personalized biotechnology interventions such as small molecule therapeutics targeting specific cellular components of the stress response, with community-embedded interventions that involve addressing psycho-socio-cultural impediments that would aim to strengthen personal/social resilience and enhance social capital.
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http://dx.doi.org/10.1111/jep.12587DOI Listing
February 2017

The trajectory of life. Decreasing physiological network complexity through changing fractal patterns.

Front Physiol 2015 2;6:169. Epub 2015 Jun 2.

Thoracic Surgery and Critical Care Medicine, University of Ottawa and Associate Scientist, Ottawa Hospital Research Institute Ottawa, ON, Canada.

In this position paper, we submit a synthesis of theoretical models based on physiology, non-equilibrium thermodynamics, and non-linear time-series analysis. Based on an understanding of the human organism as a system of interconnected complex adaptive systems, we seek to examine the relationship between health, complexity, variability, and entropy production, as it might be useful to help understand aging, and improve care for patients. We observe the trajectory of life is characterized by the growth, plateauing and subsequent loss of adaptive function of organ systems, associated with loss of functioning and coordination of systems. Understanding development and aging requires the examination of interdependence among these organ systems. Increasing evidence suggests network interconnectedness and complexity can be captured/measured/associated with the degree and complexity of healthy biologic rhythm variability (e.g., heart and respiratory rate variability). We review physiological mechanisms linking the omics, arousal/stress systems, immune function, and mitochondrial bioenergetics; highlighting their interdependence in normal physiological function and aging. We argue that aging, known to be characterized by a loss of variability, is manifested at multiple scales, within functional units at the small scale, and reflected by diagnostic features at the larger scale. While still controversial and under investigation, it appears conceivable that the integrity of whole body complexity may be, at least partially, reflected in the degree and variability of intrinsic biologic rhythms, which we believe are related to overall system complexity that may be a defining feature of health and it's loss through aging. Harnessing this information for the development of therapeutic and preventative strategies may hold an opportunity to significantly improve the health of our patients across the trajectory of life.
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http://dx.doi.org/10.3389/fphys.2015.00169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451341PMC
June 2015

Yoga and self-reported cognitive problems in breast cancer survivors: a randomized controlled trial.

Psychooncology 2015 Aug 21;24(8):958-66. Epub 2014 Oct 21.

Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, USA.

Objectives: Cancer survivors often report cognitive problems. Furthermore, decreases in physical activity typically occur over the course of cancer treatment. Although physical activity benefits cognitive function in noncancer populations, evidence linking physical activity to cognitive function in cancer survivors is limited. In our recent randomized controlled trial, breast cancer survivors who received a yoga intervention had lower fatigue and inflammation following the trial compared with a wait list control group. This secondary analysis of the parent trial addressed yoga's impact on cognitive complaints.

Methods: Posttreatment stage 0-IIIA breast cancer survivors (n = 200) were randomized to a 12-week, twice-weekly Hatha yoga intervention or a wait list control group. Participants reported cognitive complaints using the Breast Cancer Prevention Trial Cognitive Problems Scale at baseline, immediately postintervention, and 3-month follow-up.

Results: Cognitive complaints did not differ significantly between groups immediately postintervention (p = 0.250). However, at 3-month follow-up, yoga participants' Breast Cancer Prevention Trial Cognitive Problems Scale scores were an average of 23% lower than wait list participants' scores (p = 0.003). These group differences in cognitive complaints remained after controlling for psychological distress, fatigue, and sleep quality. Consistent with the primary results, those who practiced yoga more frequently reported significantly fewer cognitive problems at 3-month follow-up than those who practiced less frequently (p < 0.001).

Conclusions: These findings suggest that yoga can effectively reduce breast cancer survivors' cognitive complaints and prompt further research on mind-body and physical activity interventions for improving cancer-related cognitive problems.
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http://dx.doi.org/10.1002/pon.3707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405403PMC
August 2015

Yoga's impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial.

J Clin Oncol 2014 Apr 27;32(10):1040-9. Epub 2014 Jan 27.

All authors: The Ohio State University, Columbus, OH.

Purpose: To evaluate yoga's impact on inflammation, mood, and fatigue.

Patients And Methods: A randomized controlled 3-month trial was conducted with two post-treatment assessments of 200 breast cancer survivors assigned to either 12 weeks of 90-minute twice per week hatha yoga classes or a wait-list control. The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1β (IL-1β), and scores on the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), the vitality scale from the Medical Outcomes Study 36-item Short Form (SF-36), and the Center for Epidemiological Studies-Depression (CES-D) scale.

Results: Immediately post-treatment, fatigue was not lower (P > .05) but vitality was higher (P = .01) in the yoga group compared with the control group. At 3 months post-treatment, fatigue was lower in the yoga group (P = .002), vitality was higher (P = .01), and IL-6 (P = .027), TNF-α (P = .027), and IL-1β (P = .037) were lower for yoga participants compared with the control group. Groups did not differ on depression at either time (P > .2). Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits (P = .019; P < .001), as well as vitality (P = .016; P = .0045), but not depression (P > .05) than simple group assignment; more frequent practice produced larger changes. At 3 months post-treatment, increasing yoga practice also led to a decrease in IL-6 (P = .01) and IL-1β (P = .03) production but not in TNF-α production (P > .05).

Conclusion: Chronic inflammation may fuel declines in physical function leading to frailty and disability. If yoga dampens or limits both fatigue and inflammation, then regular practice could have substantial health benefits.
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http://dx.doi.org/10.1200/JCO.2013.51.8860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965259PMC
April 2014

Caffeine administration does not alter salivary α-amylase activity in young male daily caffeine consumers.

BMC Res Notes 2014 Jan 13;7:30. Epub 2014 Jan 13.

Department of Biobehavioral Health & Penn State Institute of the Neurosciences, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802, USA.

Background: To follow up on a recent report from our lab [Hum Psychopharmacol 25:359-367, 2010.] we examined the effects of caffeine on salivary α-amylase (sAA) activity in response to an engaging, non-stressful task in healthy young males (age 18-30 yrs) who consumed caffeine on a daily basis. Using a placebo-controlled, double-blind, between-subjects design, 45 men received either placebo, 200 mg or 400 mg of caffeine (Vivarin®). Participants then rested for 20 minutes, and performed a 20-minute computerized air traffic controller-like task that was cognitively engaging but not stressful. Saliva samples (assayed for sAA and cortisol), blood pressure, and heart rate were taken before (baseline) and 15 minutes after the computerized task.

Results: Systolic and diastolic blood pressure and sAA activity increased across the laboratory session (F's > 9.20, p's < 0.05); salivary cortisol levels decreased (F = 16.17, p < 0.05). There were no main effects for caffeine administration on sAA, salivary cortisol, or cardiovascular measures, and caffeine did not interact with the task to alter these measures.

Conclusions: Laboratory administered caffeine does not alter sAA activity, even when sAA activity is stimulated by participating in a cognitively engaging task. These data demonstrate that caffeine administration does not affect sAA activity, at least in healthy young men who regularly consume caffeine. Results support recent findings that basal caffeine levels in habitual caffeine users are not associated with basal sAA activity and that daily caffeine intake and diurnal sAA activity are not related.
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http://dx.doi.org/10.1186/1756-0500-7-30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896836PMC
January 2014

Loneliness promotes inflammation during acute stress.

Psychol Sci 2013 Jul 29;24(7):1089-97. Epub 2013 Apr 29.

Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, 460 Medical Center Dr., Columbus, OH 43210, USA.

Although evidence suggests that loneliness may increase risk for health problems, the mechanisms responsible are not well understood. Immune dysregulation is one potential pathway: Elevated proinflammatory cytokines such as interleukin-6 (IL-6) increase risk for health problems. In our first study (N = 134), lonelier healthy adults exposed to acute stress exhibited greater synthesis of tumor necrosis factor-alpha (TNF-α) and IL-6 by peripheral blood mononuclear cells (PBMCs) stimulated with lipopolysaccharide (LPS) than their less lonely counterparts. Similarly, in the second study (N = 144), lonelier posttreatment breast-cancer survivors exposed to acute stress exhibited greater synthesis of IL-6 and interleukin-1 beta (IL-1β) by LPS-stimulated PBMCs than their counterparts who felt more socially connected. However, loneliness was unrelated to TNF-α in Study 2, although the result was in the expected direction. Thus, two different populations demonstrated that lonelier participants had more stimulated cytokine production in response to stress than less lonely participants, which reflects a proinflammatory phenotype. These data provide a glimpse into the pathways through which loneliness may affect health.
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http://dx.doi.org/10.1177/0956797612464059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825089PMC
July 2013

Effects of caffeine and stress on biomarkers of cardiovascular disease in healthy men and women with a family history of hypertension.

Stress Health 2013 Dec 18;29(5):401-9. Epub 2013 Mar 18.

Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA.

The connection between caffeine and its potentially detrimental effects on blood markers of cardiovascular disease (CVD) are controversial. Most studies have focused on cholesterol as a putative mediator of the caffeine-CVD relationship. Other blood markers such as C-reactive protein (CRP) and fibrinogen have been understudied. We examined the effects of caffeine and psychological stress on these CVD markers in healthy, young men and women with a confirmed family history of hypertension. A total of 52 normotensive, healthy adults (26 men and 26 women) aged 18-29 years (21.4 ± 0.3) participated in a laboratory session to examine stress reactivity following caffeine consumption. All participants had normal cholesterol levels. Blood pressure (BP), heart rate, serum cortisol and CRP and plasma fibrinogen were collected. Men and women administered caffeine displayed an additional increase in systolic BP and cortisol response to the stressor (p < 0.05). Stress interacted with caffeine and sex to alter cortisol, fibrinogen and systolic BP but not CRP levels. These results may shed light on sex-specific pathways that associate caffeine with CVD.
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http://dx.doi.org/10.1002/smi.2486DOI Listing
December 2013

Loneliness predicts pain, depression, and fatigue: understanding the role of immune dysregulation.

Psychoneuroendocrinology 2013 Aug 27;38(8):1310-7. Epub 2012 Dec 27.

Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH 614, United States.

Objective: The pain, depression, and fatigue symptom cluster is an important health concern. Loneliness is a common risk factor for these symptoms. Little is known about the physiological mechanisms linking loneliness to the symptom cluster; immune dysregulation is a promising candidate. Latent herpesvirus reactivation, which is reflected by elevated herpesvirus antibody titers, provides a window into immune dysregulation. Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are two common herpesviruses.

Methods: Participants were 200 breast cancer survivors who were 2 months to 3 years post-treatment at the time of the study. They completed questionnaires and provided a blood sample that was assayed for CMV and EBV antibody titers.

Results: Lonelier participants experienced more pain, depression, and fatigue than those who felt more socially connected. Lonelier participants also had higher CMV antibody titers which, in turn, were associated with higher levels of the pain, depression, and fatigue symptom cluster. Contrary to expectations, EBV antibody titers were not associated with either loneliness or the symptom cluster.

Conclusions: The pain, depression, and fatigue symptom cluster is a notable clinical problem, especially among cancer survivors. Accordingly, understanding the risk factors for these symptoms is important. The current study suggests that loneliness enhances risk for immune dysregulation and the pain, depression, and fatigue symptom cluster. The present data also provide a glimpse into the pathways through which loneliness may impact health.
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http://dx.doi.org/10.1016/j.psyneuen.2012.11.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633610PMC
August 2013

Elevated thyroid stimulating hormone is associated with elevated cortisol in healthy young men and women.

Thyroid Res 2012 Oct 30;5(1):13. Epub 2012 Oct 30.

Department of Biobehavioral Health, 219 Biobehavioral Health Bldg, The Pennsylvania State University, University Park, PA, 16802, USA.

Unlabelled:

Background: Recent attention has been given to subclinical hypothyroidism, defined as an elevation of TSH (4.5-10 uIU/L) with T4 and T3 levels still within the normal range. Controversy exists about the proper lower limit of TSH that defines patients in the subclinical hypothyroidism range and about if/when subclinical hypothyroidism should be treated. Additional data are needed to examine the relationship between markers of thyroid function in the subclinical hypothyroidism range, biomarkers of health and ultimately health outcomes.

Objective: We aimed to assess the relationship between serum TSH levels in the 0.5-10 uIU/L range and serum cortisol in a cohort of healthy young men and women without clinical evidence of hypothyroidism. Based on data in frank hypothyroidism, we hypothesized that serum TSH levels would be positively correlated with serum cortisol levels, suggesting derangement of the cortisol axis even in subclinical hypothyroidism.

Methods: We conducted a cross sectional study in 54 healthy, young (mean 20.98 +/- 0.37 yrs) men (19) and women (35). Lab sessions took place at 1300 hrs where blood was drawn via indwelling catheter for later assessment of basal serum TSH, free T3, free T4, and cortisol levels.

Results: All but 1 participant had free T3 levels within the normal reference intervals; free T4 levels for all participants were within the normal reference intervals. Linear regression modeling revealed that TSH levels in the 0.5-10 uIU/L were significantly and positively correlated with cortisol levels. This positive TSH-cortisol relationship was maintained below the accepted 4.5 uIU/L subclinical hypothyroid cutoff. Separate regression analyses conducted by systematically dropping the TSH cutoff by 0.50 uIU/L revealed that the TSH-cortisol relationship was maintained for TSH levels (uIU/L) ≤4.0, ≤3.5, ≤3.0, and ≤2.5 but not ≤2.0. Linear regression modeling did not reveal a relationship between free T3 or free T4 levels and cortisol levels.

Conclusions: Results suggest a positive relationship between TSH and cortisol in apparently healthy young individuals. In as much as this relationship may herald a pathologic disorder, these preliminary results suggest that TSH levels > 2.0 uIU/L may be abnormal. Future research should address this hypothesis further, for instance through an intervention study.
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http://dx.doi.org/10.1186/1756-6614-5-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520819PMC
October 2012

Long lasting effects of smoking: breast cancer survivors' inflammatory responses to acute stress differ by smoking history.

Psychoneuroendocrinology 2013 Feb 21;38(2):179-87. Epub 2012 Jun 21.

Division of Oral Biology, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA.

Cigarette smoking continues to be the most preventable cause of illness and death and has been linked to the development and prognosis of cancer. Current smokers have higher levels of inflammation than nonsmokers, and inflammation can remain elevated in former smokers even years following cessation. Inflammation can also be enhanced by stress. This study examined cortisol and inflammatory responses to a laboratory stressor in breast cancer survivors who formerly smoked compared to their counterparts who had never smoked. Participants included 89 women (age=51.6±8.9 years) who had completed treatment for stage 0-IIIA breast cancer within the past three years and were at least two months post surgery, radiation or chemotherapy, whichever occurred last. Cortisol and interleukin-6 (IL-6) were evaluated in response to a standardized laboratory speech and mental arithmetic stressor. Former (n=25) and never (n=64) smokers did not differ by cancer stage, cancer treatment, comorbidities, time since cancer treatment, depression, or stress. Despite having similar cortisol responses to the stressor, former smokers had exaggerated IL-6 responses two hours post-stressor compared to never smokers. This effect persisted after controlling for age, BMI, time since treatment, education, and antidepressant use. An exaggerated and prolonged inflammatory response to stress could be one mechanism underlying the persistent inflammation observed in former smokers.
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http://dx.doi.org/10.1016/j.psyneuen.2012.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488120PMC
February 2013

Inflammation and reactivation of latent herpesviruses in older adults.

Brain Behav Immun 2012 Jul 1;26(5):739-46. Epub 2011 Dec 1.

Division of Oral Biology, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA.

Inflammation increases with age and is associated with many chronic diseases that are prevalent among older adults. Persistent pathogens such as latent herpesviruses and chronic bacterial infections can act as a source of inflammation. Herpesviruses, including Epstein-Barr virus (EBV) and cytomegalovirus (CMV), establish latent infections following primary infection and reactivate when the cellular immune system is compromised. EBV and CMV replication can induce proinflammatory cytokine production and thus could influence systemic inflammation. The present study addressed relationships among EBV and CMV antibody titers, and levels of C-reactive protein (CRP) and interleukin-6 (IL-6) in a sample of 222 community dwelling older adults (mean(age)=64.1±14.1 years). Participants were divided into two groups based on whether they were EBV seropositive and CMV seronegative (EBV+CMV-), or EBV and CMV seropositive (EBV+CMV+). Among individuals who were EBV+CMV-, EBV antibody titers were not associated with either CRP or IL-6 levels. However, among those who were EBV+CMV+, higher EBV antibody titers were related to elevated levels of CRP and IL-6 in those individuals with higher CMV antibody titers; there was no relationship between EBV antibody titers and CRP or IL-6 levels in those participants with lower CMV antibody titers. These data suggest that the combination of latent EBV and CMV reactivation (indexed by antibody titers) may boost CRP and IL-6 production. Thus, reactivation of multiple herpesviruses may drive inflammation and could contribute to poorer health among older adults.
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http://dx.doi.org/10.1016/j.bbi.2011.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370109PMC
July 2012

Relationships and Inflammation across the Lifespan: Social Developmental Pathways to Disease.

Soc Personal Psychol Compass 2011 Nov;5(11):891-903

Institute for Behavioral Medicine Research, College of Medicine, The Ohio State University.

There are well documented links between close relationships and physical health, such that those who have supportive close relationships have lower rates of morbidity and mortality compared to those who do not. Inflammation is one mechanism that may help to explain this link. Chronically high levels of inflammation predict disease. Across the lifespan, people who have supportive close relationships have lower levels of systemic inflammation compared to people who have cold, unsupportive, conflict-ridden relationships. Not only are current relationships associated with inflammation, but past relationships are as well. In this article, we will first review the literature linking current close relationships across the lifespan to inflammation. We will then explore recent work showing troubled past relationships also have lasting consequence on people's inflammatory levels. Finally, we will explore developmental pathways that may explain these findings.
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http://dx.doi.org/10.1111/j.1751-9004.2011.00392.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223962PMC
November 2011

Social support and socioeconomic status interact to predict Epstein-Barr virus latency in women awaiting diagnosis or newly diagnosed with breast cancer.

Health Psychol 2012 Jan 17;31(1):11-9. Epub 2011 Oct 17.

Institute for Behavioral Medicine Research, The Ohio State University, College of Medicine, 460 Medical Center Drive, Columbus, OH 43210, USA.

Objective: Both higher socioeconomic status (SES) and supportive personal relationships confer health benefits, including better immune function. This study assessed the joint impact of SES and social support on the expression of a latent herpesvirus, Epstein-Barr virus (EBV), in a group of highly stressed women.

Methods: Two-hundred and twenty four women either awaiting further evaluation following an abnormal mammogram or newly diagnosed with breast cancer completed questionnaires and provided blood samples to assess EBV viral capsid antigen (VCA) IgG antibody titers.

Results: More highly educated women with more support from friends had lower EBV VCA antibody titers, reflecting a stronger cellular immune response to the latent virus; however, among less educated women, friend support was not associated with EBV antibody titers. As revealed in an ancillary analysis, more highly educated women with more friend support had lower systolic blood pressure (SBP); however, friend support was not associated with SBP among less educated women. Neither depression nor perceived stress mediated these associations. Neither cancer status nor cancer stage among those diagnosed with cancer was significantly related to these outcomes.

Conclusion: Lower SES women may not reap the same immunological benefits from friend support when experiencing a stressful life event as their higher SES counterparts.
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http://dx.doi.org/10.1037/a0025599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254856PMC
January 2012

Fatigue and herpesvirus latency in women newly diagnosed with breast cancer.

Brain Behav Immun 2012 Mar 2;26(3):394-400. Epub 2011 Oct 2.

Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH 43210, USA.

Fatigue is a notable clinical problem in cancer survivors, and understanding its pathophysiology is important. The current study sought to determine biomarkers of fatigue that exist before cancer treatment. Relationships between the expression of latent Epstein-Barr virus (EBV) and cytomegalovirus (CMV) and fatigue were examined in 158 women newly diagnosed with breast cancer or awaiting a positive diagnostic result. Higher CMV antibody titers, but not EBV antibody titers, were associated with a greater likelihood of being fatigued. Associations between fatigue and higher CMV antibody titers remained after controlling for alcohol use, smoking, comorbidities, depressive symptoms, age, BMI, cancer stage, and sleep problems. More sleep problems and higher levels of depressive symptoms were also associated with a greater likelihood of being fatigued. CMV antibody titers, but not EBV antibody titers, were associated with higher levels of C-reactive protein (CRP), but CRP was not associated with fatigue. When the cellular immune system is compromised, reactivation of latent herpesviruses may fuel chronic inflammatory responses. Prior work has suggested that fatigue may be related to inflammation and its associated sickness behaviors; accordingly, our findings may be tapping into this same physiological substrate.
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http://dx.doi.org/10.1016/j.bbi.2011.09.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298030PMC
March 2012

Caffeine and stress alter salivary alpha-amylase activity in young men.

Hum Psychopharmacol 2010 Jul;25(5):359-67

Department of Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA.

Objective: We examined the effects of caffeine and a psychological stressor on salivary alpha-amylase (sAA) in healthy young males (age 18-30 years) who consumed caffeine on a daily basis.

Methods: Using a between-subjects, double-blind, placebo-controlled design, 45 participants received either 200 or 400 mg of caffeine (Vivarin) or placebo, rested for 20 min, and then performed 20 min of mental arithmetic. Saliva samples (assayed for sAA and caffeine), blood pressure, and heart rate were taken before (baseline) and 15 min after the math stressor (stress).

Results: Baseline sAA activity did not differ among the treatment groups; however, there was a statistically significant time by caffeine group interaction. Changes in sAA activity across the session were dependent on the amount of caffeine consumed. Following the challenge period, sAA activity among the placebo group was the lowest and sAA activity among the 400 mg treatment group was the highest. Separate repeated-measures ANOVAs conducted for each drug treatment group revealed that sAA activity increased in response to stress and caffeine (i.e., 200 and 400 mg groups) but not to stress alone (i.e., placebo group).

Conclusions: Findings provide evidence for acute sAA changes in response to caffeine and stress in habitual caffeine users.
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http://dx.doi.org/10.1002/hup.1126DOI Listing
July 2010

Application of a naturalistic psychogenic stressor in periadolescent mice: effect on serum corticosterone levels differs by strain but not sex.

BMC Res Notes 2010 Jun 17;3:170. Epub 2010 Jun 17.

Biobehavioral Health Department, 315 East Health and Human Development Building, The Pennsylvania State University University Park, PA, USA.

Background: As a first step in determining whether psychogenic stressors might be incorporated into periadolescent mouse models of stress, we evaluated whether a commonly used psychogenic stressor, exposure to red fox urine, alters serum corticosterone levels in periadolescent C57BL/6J and DBA/2J mice.

Findings: In a 1-day experiment, forty-eight 38-day-old C57BL/6J (N = 12 males; N = 12 females) and DBA/2J (N = 12 males; N = 12 females) mice were exposed to 10-min of red fox urine via cotton ball (N = 12 C57BL/6J mice; N = 12 DBA/2J mice) or to a non-saturated cotton ball (N = 12 C57BL/6J mice; N = 12 DBA/2J mice). All mice were sacrificed 15-min after cotton ball exposure and serum was collected for corticosterone assessment. Overall, there was a main effect for strain such that C57BL/6J male and female mice displayed higher corticosterone levels than did male and female DBA/2J mice. There were no main effects for sex or odor exposure. However, there was a significant strain by odor exposure interaction, whereby, within odor-exposed mice, DBA/2J mice displayed lower corticosterone levels (ng/mL) compared to C57BL/6J mice, regardless of sex. Further, among DBA/2J mice, predator odor exposure reduced corticosterone levels compared to no odor exposure.

Conclusions: Findings indicate that mouse strain, but not sex, may play an important role in the efficacy of a predator odor among periadolescent mice.
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http://dx.doi.org/10.1186/1756-0500-3-170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2896369PMC
June 2010

Female temperament, tumor development and life span: relation to glucocorticoid and tumor necrosis factor alpha levels in rats.

Brain Behav Immun 2008 Jul 21;22(5):727-35. Epub 2007 Dec 21.

Biobehavioral Health Department, 315 Health & Human Development-East, Pennsylvania State University, University Park, PA 16802, USA.

Behavioral characteristics closely associated with specific physiological profiles present an important area of research in understanding health disparities. In particular, glucocorticoid overproduction may be an important factor moderating disease progression; natural variance in production of this steroid has been proposed as one mechanism underlying individual differences in health and disease. In the current paper, we examined immune parameters in female rats of two different behavioral types previously shown to have differential glucocorticoid production and life spans. We categorized young female rats according to their behavioral response to novelty (high- or low-locomotion), and compared their glucocorticoid production, adrenal size, thymus size, tumor necrosis factor-alpha (TNF-alpha) production, tumor development and life span. As expected, high-locomotion females produced more glucocorticoids and had larger adrenal glands during young adulthood than did low-locomotion females. High-locomotion females had significantly smaller thymuses and reduced TNF-alpha levels compared to low-locomotion, suggesting altered immune function in young adulthood. Finally, high-locomotion females had shorter life spans than did low-locomotion females, and this was particularly true in females that developed pituitary tumors, but not in those that developed mammary tumors. These results, along with other published findings, suggest that high-locomotion rodent females experience life-long elevations in glucocorticoid responses to novelty, and that these elevated levels may be comparable to chronic stress. This naturally occurring endocrine profile may influence immune responses which in turn could affect disease susceptibility. Variance in immune function across personality types may be partially moderated by natural variance in glucocorticoid production.
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http://dx.doi.org/10.1016/j.bbi.2007.10.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505339PMC
July 2008
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