Self-concealment, secrecy, and guilt.

OBJECTIVE: Individuals with a tendency to conceal unflattering information about themselves are more likely to be preoccupied by their secrets and tend to report more negative affect. According to theory, this negative affect is due to self-concealers' conflicting motivation to be authentic in their relationship but fear the negative consequences should they reveal their secrets, which promotes ill-fated attempts to suppress. The purpose of the current study was to test a central component of this model. METHODS: Two studies of adults who were in a romantic relationship and keeping a secret from their partner (combined N = 635; 67.2% women; Mage  = 39.6, SD = 11.9) were surveyed on four biweekly occasions. Multilevel mediation analyses were conducted to test whether preoccupation and suppression mediated the link between self-concealing and negative affect and guilt. RESULTS: The data support the hypotheses. Self-concealers were more preoccupied with and prone to suppress their secret than those low on the trait, which, in turn, predicted greater negative affect and guilt. CONCLUSION: The findings suggest that self-concealers' insecurities and fear of the relational consequences of disclosure set the stage for the debilitating cycle of suppression and preoccupation that leaves them feeling anxious and guilty.

Community peer support among individuals living with spinal cord injury.

Peer support is widely assumed to help individuals with spinal cord injury (SCI) adjust, yet the evidence is mixed. We propose that peer support may be more likely to promote adjustment when informal support is lacking. To test this hypothesis, 135 individuals living with SCI receiving peer support (46.7% female; Mage = 42.36, SD = 14.83) completed an online survey assessing aspects of and satisfaction with the peer support and family/friend support that they were receiving as well as measures of adjustment. Although those reporting receiving more peer support were not any better adjusted than those reporting less, individuals who were more satisfied with the peer support they received reported better adjustment. Moreover, the relation of satisfaction with peer support with depressive symptoms was dependent on the level of family/friend support. These findings suggest that peer support is most effective among those lacking support from family and friends.

Mindfulness-based stress reduction and cognitive function among breast cancer survivors: A randomized controlled trial.

BACKGROUND: Breast cancer (BC) survivors frequently report changes in cognition after chemotherapy. Mindfulness may benefit survivors by mitigating cancer-related cognitive impairment. As part of a larger study investigating the effects of mindfulness-based stress reduction (MBSR) for BC survivors living with neuropathic pain, the authors assessed whether MBSR would have an effect on cognitive outcomes. METHODS: Participants were randomized to an MBSR intervention group (n = 30) or a waitlist control group (n = 30). Cognitive assessments were administered at 3 time points: at baseline, 2 weeks, and 3 months post-MBSR in the intervention group and at equivalent time intervals for the control group. Multilevel models were used to assess whether MBSR significantly improved task performance at each time point. RESULTS: MBSR participants showed a significantly greater reduction in prospective and retrospective memory failures at 2 weeks postintervention. No effects of MBSR were noted for objective assessments. CONCLUSIONS: These results suggest that MBSR training reduces subjective (but not objective) memory-related impairments in BC survivors who receive treatment with chemotherapy. This study provides insight into a noninvasive intervention to ameliorate memory difficulties in BC survivors.

On being loyal to a casino: The interactive influence of tier status and disordered gambling symptomatology on attitudinal and behavioral loyalty.

BACKGROUND AND AIMS: Casino loyalty programs are marketing strategies designed to foster attitudinal (i.e., identification and satisfaction) and behavioral (i.e., spending) loyalty among gamblers by offering rewards to members. Casino loyalty programs use a tier-based structure to segment members who spend more money into higher tiers, where they receive better rewards (compared to lower tiered members). Tier-based structures may encourage increased expenditure among patrons, especially among players living with a gambling disorder. The current work aimed to examine whether tier status and disordered gambling symptomatology interact to predict attitudinal and behavioral loyalty. METHODS: Study 1 used a cross-sectional design to examine whether tier status and disordered gambling symptomatology interact to predict self-reported loyalty among a sample of American casino loyalty program members (N = 396). In Study 2, archival player account data from Canadian casino loyalty program members (N = 649) were analyzed to examine whether tier status and disordered gambling symptomatology interact to predict objective measures of behavioral loyalty. RESULTS: The greatest effect of tier status on attitudinal and behavioral loyalty was observed among non-problem gamblers in the highest tiers. Tier status, however, did not influence loyalty among members high in disordered gambling symptomatology. DISCUSSION: Results suggest that once gambling has become problematic, loyalty programs may not influence player attitudes and behaviors. Non-problem gamblers may be particularly susceptible to the tiered structure of the programs. CONCLUSION: Non-problem gamblers may benefit from casino loyalty programs in the short-term but longitudinal research is needed to understand the long-term influence of membership.

Factors promoting greater preoccupation with a secret.

The secrets that are most taxing to one's health and well-being are those that are the most preoccupying to the secret-keeper. However, it is currently unclear what makes a secret preoccupying. We conducted a four-wave longitudinal study to assess four factors that should contribute to one's degree of preoccupation with a secret kept from one's spouse/romantic partner: perceived cost of revealing the secret, frequency of cues, fear of discovery, and individual differences in self-concealment. Multilevel modelling of data from an online sample of 143 adults (51% women, 49% men; Mage  = 39.9, SD = 9.3) keeping a secret from their spouse/partner indicated that all four factors independently and positively predict greater preoccupation with a secret. Further, the first three factors also significantly predicted how preoccupied one would be with one's secret two weeks later, taking into account how preoccupied one was with the secret at present. We conclude that the characteristics of the secret, as well as the secret-keeper, can contribute to how preoccupying a secret is to an individual.

Secrets, Psychological Health, and the Fear of Discovery.

Keeping secrets from one's partner has been associated with lower well-being and relationship satisfaction. Previous research has suggested that individual differences in self-concealment account for these effects. However, we propose that the fear of discovery (FoD)-defined as the fear that one's secret may be revealed by means other than deliberate disclosure-predicts the extent to which secrets affect well-being beyond the effects attributable to individual differences. Both a cross-sectional and a longitudinal survey (combined N = 471; 54.4% female; Mage = 39.5) of adults in romantic relationships confirmed that FoD predicted greater preoccupation with the secret, more negative affect, and less relationship satisfaction and commitment beyond that of self-concealment. Multilevel modeling in Study 2 indicated that changes in FoD predicted changes in preoccupation over time. The data are consistent with the notion that FoD promotes greater preoccupation, greater negative affect, and lower levels of relationship well-being.

Effects of weight teasing and gender on body esteem in youth: A longitudinal analysis from the REAL study.

Weight teasing is associated with body dissatisfaction, but no study has examined the differential impact of the teasing source's gender. This study examined whether the longitudinal relationship between weight teasing (by peers), weight-related comments (by parents) and body esteem differed by the teasing sources' gender, and whether these relationships were moderated by victims' weight status and demographic factors. A school-based sample (N = 1197 at Time 1; 60% female) of adolescents completed surveys over approximately 2 years (Time 1-Time 3). Multilevel modeling showed that teasing from a male peer had a stronger, negative association with appearance esteem for female victims than males. Although weight teasing was more prevalent among youth with overweight/obesity, teasing from female peers had a stronger negative association with weight esteem for adolescents of average weight. Results suggest the weight teasing sources' gender may differentially impact the victims' body esteem, and highlights the need to consider these factors in weight teasing prevention strategies.

Hope and psychological health and well-being following spinal cord injury.

OBJECTIVE: Several studies of people with spinal cord injury (SCI) have indicated that high levels of hope are linked with better adjustment, but none has assessed the extent to which hope predicts change in adjustment over time. This study examines the effect of hope assessed within the first months post-SCI onset on changes in several indicators of well-being just prior to release from institutional care and again 13 months post-SCI. METHOD: Structured interviews were conducted with 67 adults (54 men, 13 women; Mage = 44.7 years, SD = 17.2) with SCI on average 2.6 months (Time 1), 5 months (Time 2; n = 60), and 13 months post-SCI (Time 3; n = 53) using validated instruments to assess dispositional hope, depressive symptoms, subjective well-being, self-esteem, reintegration, and pain. RESULTS: Regression analyses revealed that, of the five indicators of well-being, hope at Time 1 only significantly predicted increases in subjective well-being at Time 2. However, hope predicted increased well-being on 4 of 5 indicators at Time 3. Hope was not significantly associated with changes in self-esteem at either follow-up assessment. CONCLUSION: People with high levels of hope appear to be better able to adjust to the challenges faced once they leave the rehabilitation center. Psycho-educational interventions that promote agency and pathway thinking may lead to better longer-term adjustment. (PsycINFO Database Record

A Rapamycin-Activated Caspase 9-Based Suicide Gene.

Engineered T cell therapies show considerable promise in the treatment of refractory malignancies. Given the ability of engineered T cells to engraft and persist for prolonged periods along with unpredicted toxicities, incorporation of a suicide gene to allow selective depletion after administration is desirable. Rapamycin is a safe and widely available immunosuppressive pharmaceutical that acts by heterodimerization of FKBP12 with the FRB fragment of mTOR. The apical caspase caspase 9 is activated by homodimerization through its CARD domain. We developed a rapamycin-induced caspase 9 suicide gene. First, we showed that caspase 9 could be activated by a two-protein format with replacement of the CARD domain with both FRB and FKBP12. We next identified an optimal compact single-protein rapamycin caspase 9 (rapaCasp9) by fusing both FRB and FKBP12 with the catalytic domain of caspase 9. Functionality of rapaCasp9 when co-expressed with a CD19 CAR was demonstrated in vitro and in vivo.

Interleukin 7 immunotherapy improves host immunity and survival in a two-hit model of Pseudomonas aeruginosa pneumonia.

Patients with protracted sepsis develop impaired immunity, which predisposes them to acquiring secondary infections. One of the most common and lethal secondary infections is Pseudomonas aeruginosa pneumonia. Immunoadjuvant therapy is a promising approach to reverse sepsis-induced immunosuppression and improve morbidity and mortality from secondary infections. Interleukin-7 is an immunoadjuvant that improves survival in clinically relevant animal models of polymicrobial peritonitis and in fungal sepsis. This study investigated the effect of recombinant human interleukin-7 (rhIL-7) on survival in a 2-hit model of sublethal cecal ligation and puncture followed by P. aeruginosa pneumonia. Potential immunologic mechanisms responsible for the rhIL-7 putative beneficial effect were also examined, focusing on IL-17, IL-22, IFN-γ, and TNF-α, cytokines that are critical in the control of sepsis and pulmonary Pseudomonas infections. Results showed that rhIL-7 was highly effective in preventing P. aeruginosa-induced death, i.e., 92% survival in rhIL-7-treated mice versus 56% survival in control mice. rhIL-7 increased absolute numbers of immune effector cells in lung and spleen and ameliorated the sepsis-induced loss of lung innate lymphoid cells (ILCs). rhIL-7 also significantly increased IL-17-, IFN-γ-, and TNF-α-producing lung ILCs and CD8 T cells as well as IFN-γ- and TNF-α-producing splenic T cell subsets and ILCs. Furthermore, rhIL-7 enhanced NF-κB and STAT3 signaling in lungs during sepsis and pneumonia. Given the high mortality associated with secondary P. aeruginosa pneumonia, the ability of rhIL-7 to improve immunity and increase survival in multiple animal models of sepsis, and the remarkable safety profile of rhIL-7, clinical trials with rhIL-7 should be considered.

Polytrauma Increases Susceptibility to Pseudomonas Pneumonia in Mature Mice.

Pneumonia is the most common complication observed in patients with severe injuries. Although the average age of injured patients is 47 years, existing studies of the effect of injury on the susceptibility to infectious complications have focused on young animals, equivalent to a late adolescent human. We hypothesized that mature adult animals are more susceptible to infection after injury than younger counterparts. To test this hypothesis, we challenged 6 to 8-month-old mature mice to a polytrauma injury followed by Pseudomonas aeruginosa pneumonia and compared them to young (8-10-week-old) animals. We demonstrate that polytrauma injury increases mortality from pneumonia in mature animals (sham-pneumonia 21% vs. polytrauma-pneumonia 62%) but not younger counterparts. After polytrauma, pneumonia in mature mice is associated with higher bacterial burden in lung, increased incidence of bacteremia, and elevated levels of bacteria in the blood, demonstrating that injury decreases the ability to control the infectious challenge. We further find that polytrauma did not induce elevations in circulating cytokine levels (TNF-alpha, IL-6, KC, and IL-10) 24  h after injury. However, mature mice subjected to polytrauma demonstrated an exaggerated circulating inflammatory cytokine response to subsequent Pseudomonas pneumonia. Additionally, whereas prior injury increases LPS-stimulated IL-6 production by peripheral blood leukocytes from young (8-10-week-old) mice, injury does not prime IL-6 production by cell from mature adult mice. We conclude that in mature mice polytrauma results in increased susceptibility to Pseudomonas pneumonia while priming an exaggerated but ineffective inflammatory response.

The Dark Side of Authenticity: Feeling "Real" While Gambling Interacts with Enhancement Motives to Predict Problematic Gambling Behavior.

Engaging in activities that make people feel authentic or real is typically associated with a host of positive psychological and physiological outcomes (i.e., being authentic serves to increase well-being). In the current study, we tested the idea that authenticity might have a dark side among people engaged in an addictive or risky behavior (gambling). To test this possibility, we assessed gamblers (N = 61) who were betting on the National Hockey League playoff games at a sports bar. As predicted, people who felt authentic when gambling reported behavior associated with problem gambling (high frequency of betting) as well as problematic play (a big monetary loss and a big monetary win). Moreover, such behavior and gambling outcomes were particularly high among people who were motivated to gamble for the purpose of enhancement. The interaction of feeling authentic when betting and gambling for purposes of enhancing positive emotions proved especially troublesome for problematic forms of play. Implications of authenticity as a potential vulnerability factor for sports betting and other types of gambling are discussed.

Social desirability and change following substance abuse treatment in male offenders.

The efficacy of cognitive-behavioral treatment for substance abuse is contingent on changing clients' attitudes, beliefs, and expectancies. Assessing such change with self-report instruments may be problematic in offenders to the extent that they perceive that treatment success may secure privileges. This study assesses the extent to which increases in social desirability predict improvement in self-efficacy, perceptions of control, and perceived ability to cope and resist use of drugs. Male offenders in a moderate-intensity (N = 1,431) and a high-intensity (N = 316) substance abuse program were assessed before and after treatment on a range of beliefs and attitudes targeted in treatment, along with a measure of social desirability. Regression analyses indicate that those reporting the greatest increase in social desirability also reported the greatest improvement in attitudes and beliefs about drug and alcohol use, thereby suggesting that such self-report measures of change should be regarded with a degree of skepticism.

Financial strain, social capital, and perceived health during economic recession: a longitudinal survey in rural Canada.

Although the health consequences of financial strain are well documented, less is understood about the health-protective role of social capital. Social capital refers to a sense of community embeddedness, which is in part reflected by group membership, civic participation, and perceptions of trust, cohesion, and engagement. We investigated whether perceptions of social capital moderate the relation between financial strain and health, both mental and physical. This longitudinal study surveyed adults in two communities in rural Ontario where significant job losses recently occurred. Data were collected on financial strain, social capital, perceived stress, symptoms of anxiety and depression, and physical health on three occasions over 18 months (N's = 355, 317, and 300). As expected, financial strain positively related to perceived stress, poor physical health and symptoms of anxiety and depression, whereas social capital related to less stress, better physical health, and fewer symptoms of anxiety and depression. Effects of financial strain on perceived stress and depressive symptoms were moderated by social capital such that financial strain related more closely to perceived stress and depressive symptoms when social capital was lower. The findings underscore the health-protective role of community associations among adults during difficult economic times.

Participation and well-being poststroke: evidence of reciprocal effects.

OBJECTIVE: To explore reciprocal effects between participation and emotional and physical well-being during the first 2 years poststroke. DESIGN: Prospective cohort study. SETTING: Community. PARTICIPANTS: An inception cohort of adults (N=67) who had been discharged from an acute stroke unit or stroke rehabilitation unit after a first stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participation (Reintegration to Normal Living Index), emotional well-being (General Well-being Schedule), and physical well-being (General Self-rating of Health Question) were measured at 6, 9, 12, 18, and 24 months poststroke. Hierarchical linear modeling was used to examine the association between participation and change in well-being, controlling for sex, age, impairment (discharge FIM), and median neighborhood income. RESULTS: Greater engagement in valued activities was significantly associated with subsequent improvement in emotional well-being. The effect of participation on change in physical well-being was marginal. Higher levels of well-being also predicted subsequent increases in participation, with emotional well-being effects moderated by income, and physical well-being effects moderated by level of impairment. CONCLUSIONS: Our results support a 2-pronged approach to addressing well-being poststroke where efforts to improve affect and boost participation are simultaneously applied.

Adaptation following stroke: a personal projects analysis.

OBJECTIVES: Assessment of adaptation following stroke has tended to focus either on acceptance of disability or global indicators of well-being. People with stroke, however, tend to view adaptation in terms of reengagement with personally valued activities. We model the adaptation process by assessing change in importance, control, stress, challenge, pleasure, support and self-identification of personal projects (i.e., one's current activities such as work, leisure, and recreational activities) from prestroke to 24 months poststroke. METHOD: Personal projects, general health, and general well-being were assessed via interviews with a sample of 67 community-residing stroke survivors (39 male; mean age = 64.7 years, SD = 13.2) on five occasions over the first 24 months poststroke. RESULTS: Multilevel (hierarchical) modeling of the longitudinal data indicates that project dimensions of Control, Stress, Challenge, Pleasure, and Support predict well-being in expected ways. Although projects at 6 months poststroke were rated as more important, stressful, challenging, and supported by others and less controllable and pleasurable than prestroke projects, by 12 to 18 months all project ratings had returned to prestroke levels, thereby suggesting successful adaptation. CONCLUSIONS/IMPLICATIONS: Longitudinal analysis of survivors' participation in valued activities poststroke revealed a pattern of adaptation that relates to but goes beyond that suggested by global measures of health, functioning, and well-being. The focus on adaptation of personal projects or valued activities may provide a helpful way of examining and improving well-being poststroke and offer new insights to inform the development of effective interventions for improving well-being following stroke. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Meaning-making following spinal cord injury: Individual differences and within-person change.

OBJECTIVE: Several studies of people coping with trauma or loss suggest that finding meaning in one's experience predicts better adjustment. However, these studies assume that meaning is a stable individual-difference construct. We assess the temporal stability of searching for and finding meaning in a sample of people with spinal cord injury (SCI), and test the effect of change in searching and finding meaning on depressive affect, subjective well-being (SWB), and perceived growth. METHOD: Sixty-seven adults with SCI were interviewed on 3 occasions over the first 13 months of their injury. RESULTS: Searching for and finding meaning are moderately stable over time. Multilevel analyses indicated that in addition to between-person effects of searching for and finding meaning on depressive symptoms and well-being, there was also evidence of within-person effects of searching for and finding meaning, such that more frequent searching was associated declines in adjustment, whereas increases in found meaning were associated with improved adjustment. Finding meaning, at both the between-person and within-person levels, was associated with greater perceived growth, but such growth was not associated with depressive symptoms or SWB. CONCLUSIONS: The within-person analyses demonstrate that meaning-making is a process that is not necessarily linear yet is important for understanding the process of adaptation for many people coping with SCI.

The process of re-engagement in personally valued activities during the two years following stroke.

PURPOSE: Engagement in valued activities is often difficult for people who have experienced stroke. A deeper understanding of the process of re-engagement in personally valued activities would be helpful to those designing interventions to address participation post-stroke. METHOD: Six community-dwelling individuals recovering from a first stroke were interviewed at 6, 9, 12, 18 and 24 months post-stroke. A grounded theory approach was used to construct a substantive theory of re-engagement in valued activities during this period. RESULTS: Two core concepts, social connection and being in charge were identified. Both led to activity engagement and risk taking to test abilities. These led to lowering of current expectations and activity adaptation which supported hope for recovery and further testing. Alternatively, difficulties perceived to be related to ageing led to disengagement. CONCLUSIONS: Rehabilitation practice that addresses and supports autonomy, social connection, risk taking, adaptation and hope among stroke survivors may help individuals regain personally valued activities post-stroke.

TLR3 agonist improves survival to secondary pneumonia in a double injury model.

BACKGROUND: Toll-like receptors (TLR) can initiate various immune responses and are therefore activated under diverse infectious states. Previous studies have focused on TLR3 primarily as an antiviral pathway. However, recent research has demonstrated its efficacy in bacterial infection. Having developed a murine double injury model of cecal ligation and puncture (CLP) followed by Pseudomonas aeruginosa (Pa), we hypothesized that targeted administration of Poly I:C, a TLR3 agonist, would protect mice against secondary pneumonia. MATERIAL AND METHODS: B6 mice underwent CLP followed 4 d afterward by an intranasal dose of Pa. Animals were given Poly I:C or vehicle (phosphate-buffered saline) intranasally 24 h post CLP and every day thereafter for a total of 6 d. For acute studies, mice were sacrificed at two time points, 4 d post CLP and 1 d post pneumonia (Pa). RESULTS: Poly I:C treatment led to a significant improvement in survival (69% versus 33%). Cytokine analysis from bronchioalveolar lavage displayed significant differences both immediately before and after pneumonia. Bronchioalveolar lavage cultures taken at 24 h post double injury showed significantly higher colony counts in the lungs of control animals compared with those of Poly I:C animals. Measurements of TLR3 expression showed significant increases within both the immune and lung epithelial cells of Poly I:C-treated mice. Finally, the lungs of treated animals had significant increases in lymphocytes and innate cells. CONCLUSIONS: The prophylactic treatment applied in this clinically relevant model further illustrates the overarching hypothesis of immune dysfunction and the possibility of corrective immune modulation within the setting of sepsis.

Posttraumatic Chondrocyte Apoptosis in the Murine Xiphoid.

OBJECTIVE: To demonstrate posttraumatic chondrocyte apoptosis in the murine xiphoid after a crush-type injury and to ultimately determine the pathway (i.e., intrinsic or extrinsic) by which chondrocytes undergo apoptosis in response to mechanical injury. DESIGN: The xiphoids of adult female wild-type mice were injured with the use of a modified Kelly clamp. Postinjury xiphoid cartilage was analyzed via 3 well-described independent means of assessing apoptosis in chondrocytes: hematoxylin and eosin staining, terminal deoxynucleotidyl transferase dUTP nick end labeling assay, and activated caspase-3 staining. RESULTS: Injured specimens contained many chondrocytes with evidence of apoptosis, which is characterized by cell shrinkage, chromatin condensation, nuclear fragmentation, and the liberation of apoptotic bodies. There was a statistically significant increase in the number of chondrocytes undergoing apoptosis in the injured specimens as compared with the uninjured specimens. CONCLUSIONS: Chondrocytes can be stimulated to undergo apoptosis as a result of mechanical injury. These experiments involving predominantly cartilaginous murine xiphoid in vivo establish a baseline for future investigations that employ the genetic and therapeutic modulation of chondrocyte apoptosis in response to mechanical injury.