Dedicated to the Integration of Biological, Psychological and Social Factors in Medicine

71st Annual Scientific Meeting March 13-16, 2013

“IMPACT AND INNOVATION”

Meeting Abstracts

InterContinental Miami Miami, Florida, USA

American Psychosomatic Society 71st Annual Scientific Meeting Miami, Florida ~ March 13 - 16, 2013 ~ Program Schedule-at-a-Glance Abstracts are grouped by symposia, followed by all of the paper presentations, and conclude with all of the poster presentations.

Wednesday, March 13 8:00-12:30 Young Investigator Colloquium 1:30-4:30 Half Day Worshops: Meta-analysis; Assessment and Treatment of Depression in Medically Ill Patients 5:00-6:00 Opening Session/Distinguished Scientist Award 6:00-7:30 Citation Poster Session (p. A49-A59) and Reception 7:30-8:30 Student Mixer Thursday, March 14 8:15-9:15 Plenary Session: Beyond Allostatic Load 9:15-9:45 Data Blitz 10:00-11:00 Symposium 130: The Impact of Mindfulness-Based Interventions (p. A2-A3) Paper Session: Social Rejection, Exclusion and Evaluation (p. A19-A20) Paper Session: Sleep and Fatigue (p. A20-A21) Paper Session: Socioeconomic Status and Health (p. A21-A22) 11:15-12:30 Invited Symposium: Psychosomatic Science in the Media Symposium 131: Social and Emotional Neurobiology (p. A3-A4) Paper Session: Cancer (p. A22-A24) Paper Session: Acute and Chronic Stress (p. A24-A25) 12:30-1:30 Lunch on your own/Roundtable Lunches/Committee Meetings 1:45-3:00 Invited Symposium: Positive Psychobiology Symposium 132: Lights Out: Sleep, Nocturnal Physiology and the Social Context (p. A4-A5) Symposium 124: Innovative Methods at the Intersection of Biobehavioral Medicine (p. A5-A6) Paper Session: Depression, Insulin Sensitivity and Diabetes (p. A25-A27) 3:15-4:15 Symposium 120: Blunted Physiological Responses to Acute Psychological Stress (p. A6-A7) Paper Session: Relationship Quality and Health (p. A27-A28) Paper Session: Obesity and Overweight (p. A28-A29) Paper Session: Biobehavioral Models of Psychiatric Health (p. A29-A30) 4:30-5:30 Plenary Session: How APS Tames Both Psychobabble and Neuromania 5:30-7:00 Poster Session 1 (p. A60-A95) 7:30-8:30 Mentor & Mentee Reception Friday, March 15 8:15-9:15 Plenary Session: A Fantasy for Future Clinical Decision-Making: The Groundwork 9:15-9:45 Data Blitz 10:00-11:00 Symposium 126: Childhood Roots of Adult Cardiovascular Risk (p. A7-A8) Paper Session: Autonomics and Blood Pressure (p. A30-A32) Paper Session: Physical Activity (p. A32-A33) Paper Session: Dyadic Approaches (p. A33-A34) 11:15-12:30 Invited Symposium: Socio-Cultural Factors and Cardiometabolic Health in Hispanics/Latinos Symposium 143: Autonomic Nervous System Activity in the Metabolic Syndrome (p. A8-A10) Paper Session: Emotion, Physiology and Health (p. A35-A36) Paper Session: Interventions (p. A36-A38) 12:30-1:30 Lunch on your own/Roundtable Lunches/Committee Meetings 1:45-3:00 Invited Symposium: The Next Generation of Patient Reported Outcomes: The PROMIS® Initiative as a Prototype Symposium 140: Accelerated Cellular Aging: Impacted by Psychological and Behavioral Factors… (p. A10-A11) Symposium 134: Current Perspectives on Maternal-Child Health in the Perinatal Period (p. A12-A13) Paper Session: Psychoneuroimmunology (p. A38-A39) 3:15-4:15 Symposium 135: New Innovations in Neuroimaging of Autonomic Regulation (p. A13-A14) Paper Session: Depression and Cardiovascular Disease (p. A39-A41) Paper Session: Rumination (p. A41-A42) Paper Session: Maternal-Fetal Health (p. A42-A43) 4:30-5:30 Plenary Session: Why Do Americans Live Shorter, Less Healthy Lives? 5:30-7:00 Poster Session 2 (p. A96-A132) 7:30 Past Leader Dinner Saturday, March 16 8:15-9:45 Members Meeting 10:00-10:30 Data Blitz 10:30-12:30 Awards Presentations and Lectures: Paul D. MacLean; Herbert E. Weiner; and Patricia R. Barchas Awards 12:30-1:30 Lunch on your own/Roundtable Lunches/Committee Meetings 1:45-3:00 Symposium 118: Sleep and Disease: Autonomic and Inflammatory Pathways (p. A14-A15) Symposium 122: Beyond Salivary Cortisol: Salivary Biomarkers of Immune Function (p. A15-A17) Symposium 113: Psycho-Oncology Meets Psychoneuroimmunology at the Cutting Edge (p. A17-A18) Paper Session: Trauma and PTSD (p. A43-A45) 3:15-4:15 Paper Session: Discrimination (p. A45-A46) Paper Session: Pain (p. A46-A47) Paper Session: Psychoneuroendocrinology (p. A47-A48) 4:30-5:30 Presidential Address: To Sleep, Perchance to Heal 5:30-7:00 Poster Session 3 (p. A133-A166) 7:30 Banquet

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MBRP stressor-induced increases in HF-HRV were inversely related to anxiety. Tonic HF-HRV was highly correlated with HRR in MBRP but not RP or SA, suggesting cardiac vagal control contributes to regulation of HRR following MBRP. The absence of correlation for RP and SA suggest self-regulation is lacking, as the vagal brake was not recruited during stress. Changes in low frequency (LF)-HF HRV ratio were highly correlated with HRR for RP but not MBRP or SA suggesting that the vagal brake is not modulating sympathoexcitatory circuits involved in stress. Our findings will be discussed in light of neurovisceral integration model and polyvagal theory which posit higher brain and cardiac vagal mechanisms over stress responses as adaptive and thus potentially beneficial to substance abusers desiring abstinence.

SYMPOSIA

Symposium 130 THE IMPACT OF MINDFULNESS-BASED INTERVENTIONS ON MECHANISMS OF STRESS REACTIVITY & RECOVERY Jeffrey Greeson, PhD, Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, Haley Douglas, BS, Psychology, University of Washington, Seattle, WA, Elizabeth A. Hoge, MD, Psychiatry, Harvard Medical School / Massachusetts General Hospital, Boston, Massachusetts, Margaret A. Chesney, PhD, Medicine, University of California San Francisco, San Francisco, CA Numerous meta-analyses and special journal issues increasingly validate the clinical effectiveness of mindfulness-based interventions, yet relatively little is known about underlying psychological, physiological, and biochemical mechanisms of action. This symposium therefore aims to address a vitally important, yet underrepresented, area of scientific inquiry, with implications for optimizing clinical outcomes of mindfulness-based interventions by better understanding mechanisms. The first talk in this symposium will present results from a randomized clinical trial (RCT) of MBSR for patients with generalized anxiety disorder -- a mental health condition characterized by heightened sensitivity to emotional stress and physiological hyper-responsiveness. This first talk will feature changes in emotional and hypothalamic-pituitary-adrenal (HPA) axis reactivity to the Trier Social Stress Test following MBSR training compared to an active (Stress Management Education) control group that was not trained in mindfulness or meditation. The second talk will present RCT results from an innovative mindfulness-based intervention for patients with substance use disorders, called Mindfulness-Based Relapse Prevention (MBRP). This second talk will feature intervention-related changes in heart rate reactivity, heart rate variability (HRV), and drug craving to a cognitive stressor across three study arms: MBSR, traditional Relapse Prevention without mindfulness training, and Standard Aftercare. The third talk will present results from an open trial of MBSR that examines changes in affective, cardiovascular, and catecholamine responses to the Anger Recall Task -- an emotion induction task in which individuals are asked to describe a personally salient incident “that still makes you angry." This third talk will deconstruct MBSR-related changes in terms of baseline (resting), stress reactivity, and recovery effects. The Discussant, a regarded expert in the area of stress management, meditation, and psychophysiology, will summarize, integrate, and critically analyze the three presentations to highlight innovations in scientific approach and to discern clinical impact.

Individual Abstract Number: 334 MINDFULNESS MEDITATION FOR GENERALIZED ANXIETY DISORDER: EFFECTS ON RESILIENCE, ANXIETY, AND HYPOTHALAMIC PITUITARY ADRENAL (HPA) AXIS Elizabeth A. Hoge, MD, Christina A. Metcalf, B.A., Laura K. Morris, B.A., Naomi M. Simon, MD, Psychiatry, Harvard Medical School / Massachusetts General Hospital, Boston, Massachusetts Previous studies suggest that mindfulness meditation may decrease anxiety and emotional reactivity. However, many published trials do not control for non-specific effects of treatment. In this RCT, we utilized an active control condition (Stress Management Education) matched for time and attention with MBSR, but containing no mindfulness meditation. We hypothesized that patients learning mindfulness meditation would have a greater decrease in anxiety symptoms, and greater resilience to acute emotional stress, defined by less activation of the HPA axis. In order to test “resilience,” subjects were asked to complete a laboratory behavioral stress challenge. The Trier Social Stress Test (impromptu public speaking and arithmetic performance) was administered at baseline and post-intervention. Subjects rated their anxiety and performance, and blood was collected in sequential measurements throughout the task for adrenocorticotropic hormone (ACTH) levels. The MBSR group (n=40) had a greater decrease in self-rated anxiety compared to the control group (n=33, p 50,000) and merged them with mortality data (>5000 events) assessed 8-9 years following the baseline assessment of income and health status. Family income (from wages, social security, etc.) was classified in 11 categories ranging from $75,000. In the full sample mortality showed a generally linear pattern of decreased mortality across 11 income categories with unadjusted rates from 95 (lowest income) to 18 (highest income) deaths per 100,000 people (95% CI’s 90-100 and 16-20). When analyses were restricted to working-aged adults (< 65 years old) the rates ranged from 44 to 11 (95% CI’s 39-50 and 9-13), leveling off above $35,000 per year. A similar threshold pattern was observed when limiting analyses to those free of baseline disease (cancer, heart disease, stroke) and any functional limitation. Thus, a linear association of mortality risk was observed across the income spectrum in the full sample but the mortality differences shrank and took a more threshold form when analyses were limited to initially healthy and/or working-aged adults. Assertions regarding the shape of the income-mortality gradient in the US should be qualified by initial mortality risk, age and initial health status.

SESSION: Cancer Abstract 80 LOW EMOTIONAL SUPPORT FROM DIFFERENT SOURCES AND PRO-INFLAMMATORY AND PRO-METASTATIC LEUKOCYTE GENE EXPRESSION IN WOMEN AFTER SURGERY FOR BREAST CANCER Devika R. Jutagir, B.A., Lisa M. Gudenkauf, B.S., Psychology, University of Miami, Coral Gables, FL, Bonnie Blomberg, Ph.D., Microbiology and Immunology, University of Miami, Miami, FL, Jamie M. Stagl, M.S., Charles S. Carver, Ph.D., Psychology, University of Miami, Coral Gables, FL, Suzanne Lechner, Ph.D., Stefan Glück, M.D., Ph.D., Sylvester Comprehensive Cancer Center, Alain Diaz, M.S., Microbiology and Immunology, University of Miami, Miami, FL, Susan Lutgendorf, Ph.D., Psychology, University of Iowa, Iowa City, IA, Steve Cole, Ph.D., Medicine, University of California, Los Angeles, Los Angeles, CA, Michael H. Antoni, Ph.D., Psychology, University of Miami, Coral Gables, FL Objective: Emotional support (ES) is associated with less adversity and better adaptation in women with breast cancer (BCa). Adversity and ES have been related to differential leukocyte inflammatory signaling in cancer patients. In this study, we relate ES to pro-inflammatory and pro-metastatic leukocyte gene expression in women under treatment for early BCa. Methods: Leukocyte gene expression was measured by microarray analysis of peripheral blood mononuclear cells, and ES was assessed with the Sources of Social Support Scale (SSSS) in 80 women with non-metastatic BCa 2-10 weeks after surgery, before adjuvant treatment. Relative gene expression between levels of ES Total and ES from health care providers and family were compared. Results: Analysis of covariance compared gene expression in women with low ES (≤1 SD below mean) vs. high ES (≥1 SD above mean) on each SSSS subscale. Women with low total ES had greater proinflammatory (IL-1A, PTGS2, CCL20) gene expression (all ps.31). PA was not associated with any eating behaviors (ps>.10). Time lagged analyses support the view that mood effects may be consequences, rather than antecedents, of eating behavior (ps>.05 for all antecedent analyses). Results show higher negative mood did not precede unhealthy eating and weight control behaviors, but was higher when women had recently engaged in these behaviors. This study provides "real-world" and "real-time" evidence for an association between unhealthy eating behaviors and negative (but not positive) mood in young women exhibiting sub-clinical disordered eating behavior. These findings elucidate processes in daily life that may influence the development and maintenance of unhealthy eating and weight control behaviors, which in turn can inform health behavior interventions (e.g., for obesity, diabetes, eating disorders, etc.).

Abstract 174 EMOTIONS, SYMPTOMS AND ACTIVITY PATTERNS IN CHRONIC FATIGUE SYNDROME: AN EXPERIENCE SAMPLING METHODOLOGY STUDY. Alison J. Wearden, PhD, Christine Barrowclough, PhD, Rebecca Band, MSc, Kim Caldwell, MSc, School of Psychological Sciences, University of Manchester, Manchester, UK, UK Background: People with chronic fatigue syndrome frequently describe an uncertain course with fluctuations in symptoms. The cognitive behavioural model of chronic fatigue syndrome suggests that fatigue may be maintained in part by activity limitation or prolonged rest during symptomatic periods. Another activity pattern is higher activity levels (“all-or-nothing behaviour”) when feeling relatively well, followed by extended rest. The present pilot study used experience sampling methods to test these hypothesised interrelations between emotional states, symptom levels and activity management. Method: Twenty participants with a diagnosis of CFS (mean illness duration 7 years) were supplied with specially programmed mobile phones which beeped at ten unpredictable time points throughout the waking hours of each day, over six consecutive days. At the beeps, questions were delivered on the phone relating to mood, symptoms, and activities. Questions referred both to the time the beep went off and to the time elapsed between the current and previous beep. Results: Multilevel regression analyses were conducted using all available data (1198 data points). Symptom severity and negative affect were highly correlated at the same beep. Resting was associated with a higher symptom load at previous, current and subsequent beeps (all p 0.35, with the exception of the suicidal ideation item (0.31). The one-factor solution was further confirmed by the minimum average partial correlation selection procedure. Conclusion: Both CFA and EFA of the PHQ-9 in hospitalized systolic heart failure patients support a 1-factor solution, suggesting that the questionnaire may be unidimensional when assessing depression in this population.

36) Abstract 197 ILLNESS PERCEPTIONS PREDICT HEALTH PRACTICES AND MENTAL HEALTH FOLLOWING HEMATOPOIETIC STEM CELL TRANSPLANTATION Ashley M. Nelson, BA, Kathryn A. Schmidt, BA, Psychiatry, Mark B. Juckett, MD, Medicine, Carbone Cancer Center, Christopher L. Coe, PhD, Psychology, Erin S. Costanzo, PhD, Psychiatry, Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI Beliefs about illness are thought to shape health practices and coping efforts. The present study investigated illness perceptions among hematologic cancer patients undergoing hematopoietic stem cell transplant (HSCT). We also examined the extent to which perceptions predicted health practices and mental health following transplant. Participants (N = 311) completed measures of illness perceptions (beliefs about cancer course, cancer consequences, personal and treatment control over cancer, and understanding of one’s cancer) prior to HSCT. Assessments of health practices (diet, physical activity, alcohol use) and mental health (depression, anxiety, psychological well-being) were assessed pre-transplant and 1, 3, 6, and 12 months post-transplant. On average, HSCT recipients viewed their cancer to be more of an acute than chronic condition, perceived their cancer to have severe consequences, and believed they had moderate personal control over their cancer but that treatment had more control. Mixed effects linear regression models adjusting for graft type, age, and gender revealed that HSCT recipients who perceived the consequences of their cancer to be more serious experienced greater depression (z = 5.11, p < .001) and anxiety (z = 2.52, p < .05) and less psychological well-being (z = -3.60, p < .001) during the year following transplant. Those with a greater sense of personal and treatment control ate a healthier diet (z = 2.48, p < .05; z = 2.24, p < .05) and reported greater well-being (z = 3.47, p < .01; z = 5.60,

38) Abstract 722 RELATIONS OF FASTING GLUCOSE TO NEUROCOGNITIVE FUNCTION AMONG NON-DIABETIC OLDER ADULTS Regina C. Sims, Ph.D., Nursing, University of Delaware, Newark, DE, Leslie I. Katzel, M.D., Ph.D., Medicine, University of Maryland School of Medicine, Baltimore, MD, William F. Rosenberger, Ph.D., Statistics, George Mason University, Fairfax, VA, Zorayr Manukyan, Ph.D., Research and Development, Biogen Idec, Cambridge, MA, Shari R. Waldstein, Ph.D., Psychology, University of Maryland, Baltimore County, Baltimore, MD Type 2 diabetes shows well-established relations to lowered levels of cognitive performance. However, little is known about relations

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between fasting glucose levels and glucose metabolism to neurocognition among non-diabetic older adults. The aims of the present study were to examine relations of fasting glucose and glucose tolerance to cognitive function; and 2) examine age, sex, and education as potential moderators of these associations. The participants were 172 non-diabetic, stroke- and dementia-free adults with a mean age of 66.5 years. The sample was 58% male with a mean level of education of 16.3 years. Participants completed neurocognitive tests that assessed attention, memory, executive functions, visuospatial skills, and psychomotor abilities. An oral glucose tolerance test was administered. Multiple regression analyses, adjusted for age, education, sex, depression, systolic blood pressure, body mass index, and antihypertensives were computed to examine relations of fasting glucose, 2 hour glucose, and 2 hour area-under-the-curve measures to cognitive performance also examined were interactions of glucose measures with age (≤70 vs. >70 y), sex, and education (