Stress seems to be an unpleasant, but essential component to human lifestyle. Adverse situations happen in life, and rarely anyone is an exception. However , the same negative existence events can result in different results depending on the person that faces them. To paraphrase the common phrases, “what does not kill you (just) makes you stronger. The question of what inner resources help one cope with stressful “lemons in their life, and maybe, “make lemonade out of these has extended attracted focus of philosophers, writers, moviemakers, and at some point everybody who has knowledgeable negative existence events.
It is not astonishing that the concern of specific differences in respond to stress continues to be extensively explored in mindset. Individual dissimilarities may vary by situational assets, such as social support, to personal resources, such as certain personality traits (e. g., hardiness, informative style, confidence, self-esteem, emotional control, and so forth ) These psychosocial assets strongly effect both psychological and physical outcomes of stress.
The Alameda County Study demonstrated that those individuals that had more ties with their community and social network resided longer (Berkman & Syme, 1979).
Receiving social support helped females with ovarian cancer handle their condition better (Costanzo et ing., 2005), while social seclusion strongly improved the likelihood of cerebrovascular accident recurrence in patients with stroke (Boden-Albala, 2005). Lack of social support strongly predicted elevated levels of anxiety and stressed out mood (Godin, 2004). Individuality resources may also be helpful people cope with stressful existence events.
For example , optimistic informative style was associated with substantially fewer physical complaints in college students (Carver & Scheier, 1999), although pessimistic explanatory style improved symptoms of major depression (Bennett & Vanderbilt, 2002). Perceived control also appears to mitigate the consequence of stressful lifestyle events (Frazier, 2004). Finally, almost 3 decades of exploration on the moderating effect of hardiness has linked this persona resource to physical and mental well being (Maddi, 1999).
Specifically, hardiness is associated with fewer indications of depression (Oman, 2003) and burnout (Cilliers, 2003), and it physical strain too (Beasley, 2003). The list of personal and situational resources moderating the effect of adverse lifestyle events is definitely far from being finish; in fact , it could be quite comprehensive. Given the strong moderating effect of psychological resources in mental and physical health established by the previous research, the questions that arise, including how exactly perform these resources affect health?
Are there any physical differences in the way in which those individuals who have more psychosocial resources, and people individuals who have fewer resources, interact with stress? This current study aims to answer this kind of question to find the effect of personality hardiness on physical outcomes of stress. Studies have shown that hardy persons appear to thrive on stress filled life events (Maddi, 1999).
Hardy people are committed to their very own work and family, they perceive control of their life circumstances, and so they perceive demanding life events as a chance for development and growth, rather than a danger (Maddi, 2002). Hardiness is an important moderator of stress response, yet small research has researched the differences in the physiology of stress replies in high hardy vs . low-hardy persons. Previous exploration found that increased physical reactivity to stress (for case in point, in terms of blood vessels pressure) is associated with detrimental health final results, such as hypertension.
However , hardiness has been strongly linked to better health final results of pressure (Beasley, 2003; Cilliers, the year 2003; Maddi, 2002, Oman, 2003). Previous studies have also demonstrated that the same blood pressure boosts can be created by different hemodynamic mechanisms, with negative or perhaps neutral implications for health (Sherwood ainsi que al., 1999). The goal of this current study is to clarify just how hardiness takes its effect on overall health in terms of the psychophysiology of human tension responding. The Biopsychosocial Type of Challenge and Threat
With this paper, the physiological response to stress is usually conceptualized in the biopsychosocial type of challenge and threat paradigm developed by Blascovich, Mendes, Tomaka, and acquaintances (Blascovich, Mendes, Tomaka, Salomon, & Seery, 2003; Seery, Blascovich, Weisbuch, & Vick, 2004). Within a series of research, Blascovich, Tomaka, and fellow workers demonstrated that risk and obstacle appraisals are associated with distinctive patterns of cardiovascular response during a goal-relevant, motivated-performance activity (Blascovich ou al., 1999).
In Obrist’s terms (1983), this type of job involves energetic coping. In order to evoke the two challenge and threat reactivity, the task ought to be engaging and psychologically concerning, such as having a test, making a good impression, giving a presentation, and engaging in athletic competition (Seery et al., 2004). Challenge appraisals are associated with positive affectivity, greater engagement in the situation, and are mediated by myocardial response; whereas risk appraisals are associated with bad affectivity and blood pressure reactions that are mediated by the vascular resistance.
Concern and risk are known by within total peripheral resistance (TPR; the index of net constriction of the blood vessels) and heart failure output (CO; the amount of blood pumped by heart every minute). In relative conditions, greater COMPANY and lesser TPR reveal greater challenge/lesser threat response profile. In accordance to biopsychosocial model, menace reactivity can be associated with harmful health final results of tension. Blascovich and colleagues attached Lazarus and Folkman’s (1984) transactional type of stress and coping to physiological respond to stress regarding myocardial and vascular hemodynamic profiles.
Relating to Lazarus and Folkman (1984), when the individual confronts new or changing environment, he/she attempts to determine this is of the function (“primary appraisal). Primary appraisal is concerned with whether the function is likely to be neutral, positive, or negative in its consequences. Unfavorable events could possibly be appraised with regards to future destruction potentially created by the event (“threat), or since damage that has already been manufactured by the event (“harm), or when it comes to one’s potential to overcome the wedding and perhaps actually benefit from it (“challenge).
Secondary appraisal is involved with the evaluation of whether one’s resources are sufficient to satisfy the risk, harm, or challenge. The total amount between the major and second appraisal decides one’s experience of stress. Blascovich and colleagues (Blascovich ain al., 2003) conceptualized threat/challenge essentially when it comes to the ratio between the main appraisal and secondary evaluation. In addition , in their approach, principal appraisal involves estimations of danger, uncertainness, and essential effort.
Hazard, uncertainty, and effort define just how demanding the case is. The subjective connection with stress after that depends on the proportion between the demand and one’s coping methods. If the demand is large, and the solutions are low, the individual seems threat. In case the demand is high, but at the same time the coping methods are satisfactory to meet it, the individual seems challenge. Risk appraisal implies the aversive experience in this the individual anticipates damage through the situation, and presumably activities negative affectivity, such as dread, anxiety and anger.
As opposed, challenge assessments are considered less aversive, which has a primary focus on the potential for development or gain that can range from situation, although damage is usually possible. Obstacle appraisals are therefore in theory associated with increased motivation and positive affectivity, such passion, excitement, and exhilaration. To reiterate, it’s the threat appraisal that generally accounts for perceived stress (Tomaka & Palacios-Esquivel, 1999). Blascovich and fellow workers conceptualize risk and challenge as two opposite items on the solitary appraisal procession.
This is also not the same as Lazarus and Folkman’s conceptualization of danger and obstacle as not mutually exclusive evaluations. Lazarus and Folkman’s (1984) concept of evaluation has come below considerable critique (Zajonc, 2000). Zajonc is convinced that cognitive appraisal and affective knowledge are “distinct, conceptually separable processes (Zajonc, 2000, g. 31). The appraisal theories of sentiment were regarded too “cognitive, conscious, and slow, because appraisal typically occurs subconsciously and quickly.
The advocates of appraisal theories react that evaluation does not need to become conscious since it often occurs unconsciously, instantly, and very quickly, and appraisal may be combined with subcortical and also cortical processing (Ellsworth, Scherer, & Forgas, 2003). That’s why, according to appraisal theorists, although nerve-racking experience is identified as a combination of appraisals, it is not skilled as such (Ellsworth, Scherer, & Forgas, 2003). However , this will make appraisal difficult to study.
Self-reports might not sufficiently reflect a person’s appraisal, also because appraisal is assessed posteriormente, a wide variety of confounding variables might interfere with correct measurement. Within the biopsychosocial type of challenge and threat, evaluation is came up with as a procedure involving both unconscious and conscious procedures; and therefore the easiest way to investigate evaluation would be to adjust the task inside the experiment, although subjective assessments are considered a lot less reliable (Blascovich et al., 2003). The biopsychosocial version is based on Dienstbier’s (1989) study.
Dienstbier (1989) argued that you have two responsable of stress response, sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenocortical (HPA), both of which usually serve to mobilize energy stores. However , SAM activation requires the release of catecholamines, which include epinephrine and norepinephrine, that have a half-life in the body to get only a few minutes, whereas HPA activation entails the release of cortisol, that has a half-life in your body for approximately 90 minutes. Thus, SAM allows for rapid energy mobilization, whereas HPA requires long-term mobilization of energy methods.
Dienstbier’s (1989) argued that fast significant SAM response to the acute stressors along with low HPA response is usually indicative from the organism’s physiological toughness and adaptive design of tension responding. In respect to Frankenhauser (1983), MIKE activation can be associated with increased coping efforts, whereas HPA activation shows greater negative affect. Equally Frankenhauser (1983) and Dienstbier (1989) believed that the stressors involving joint activation of the SAM and HPA have the most detrimental influence on health.
For instance , individuals with hypertonie were found to have the two higher diastolic blood pressure reactivity and larger cortisol reactivity to stress (Nyklicek, Bosch, & Amerongen, 2005). Thus, joint SAM axis and HPA axis activation is noticed in hypertensive persons, i. e., the group that has customarily been discovered to be especially vulnerable to the effect of demanding life incidents. Blascovich ainsi que al. (2003) argued that challenge demonstrates primarily SAM axis of stress response, whereas menace reflects joint activation in the SAM and HPA axes of stress response.
Blascovich and fellow workers did not empirically test this kind of assumption. This conceptualization of the treat and challenge profiles as reflections of sympathetic/HP A reactivity has come under considerable criticism in the latest literature. Wright and Kirby (2003) argued that this theory may not indicate the true activation of the pressure response program, and it takes to be analyzed empirically just before one can count on the supposition. The Effect of Individual Distinctions on Hemodynamic Response to Stress
Individual variations in hardiness might have influence on one’s respond to stress. To comprehend the effect of individual differences on the physiological response to stress, it is important to establish in case the hemodynamic profile is a attribute if the specific, or a function of the scenario. Would a unique situation elicit the same hemodynamic response in all individuals? Or perhaps, is the hemodynamic response a well balanced individual attribute? To answer this question, you ought to consider the study on the persistence of hemodynamic profiles across diverse jobs and over period.
Previous study suggested that hemodynamic responses are to some extent situation-specific. The myocardial hemodynamic profile is definitely evoked by tasks that require active coping (Obrist, 1983) or flight or fight response; although vascular hemodynamic response is definitely evoked by tasks that require passive strength and offer tiny control, just like cold stress factor tasks. Blascovich and co-workers (Mendes, Blascovich, Lickel, et al., 2002) used a speech delivery task to validate their theory.
The participants were instructed to offer a talk in the existence of either a same-group spouse (challenge) or perhaps an out-group partner (threat). As expected, the TPR response was bigger in the danger condition, although CO response was bigger in the concern condition. Maier, Waldstein, and Synowski (2003) used a computerized mental arithmetic job to find that challenge evaluation was associated with greater positive affect and task involvement, whereas danger appraisal was related to higher negative influence and recognized stress.
Prkachin, Mills, and Husted (2001) found that anger-inducing interview led to the vascular response, whereas mental arithmetic led to the myocardial response. Hartley, Ginsburg, and Heffner (1999) showed their participants a previously registered videotape, by which they were disclosing personal information regarding themselves. The participants inside the active state were allowed to mark the segments with the tape, that they wanted to re-shoot before the tape was “evaluated by the reviewer; whereas the participants inside the passive state were not permitted to mark the segments with the tape.
Both equally conditions developed similar height in blood pressure; however , inside the active condition, blood pressure elevation was elicited through myocardial mechanism, while in the unaggressive condition, stress elevation was elicited through the vascular mechanism. Gregg, Wayne, Matyas, and Thornsteinsson (1999) found that mental math task elicited myocardial response, and frosty pressor process elicited vascular response.
Quigley, Barrett, and Weinstein (2002) did a within-subject examination of heart reactivity to the different jobs, and found that greater COMPANY was linked to greater obstacle implied by task (serial subtraction); however , there was no difference in TPR. Though Quigley and colleagues (2002) investigated the differences in physiological reactions produced by different responsibilities within the people, they did not really investigate the consistency of these reactions inside the individuals themselves, i. electronic.
, how stable was the hemodynamic response in a given person across different tasks. Earlier research has proven that in least some parameters of cardiovascular reactivity may be steady characteristic, just like blood pressure reactivity. In other words, the individuals with higher blood pressure reactivity would constantly exhibit this kind of response routine in different situations. Sherwood ainsi que al. (1999) argued that hemodynamic single profiles also symbolize a trait, since individuals can exhibit a specific type of response across diverse tasks.
Yet , this is a really “relative inclination as it is determined by comparison to individuals. So instead of always responding within a fixed method to all conditions, a particular individual would only show more/less myocardial/vascular response comparing to other people in the framework of a offered task. Additionally , Sherwood ainsi que al. (1999) argued the individual’s trend to exhibit a specific hemodynamic response profile can be stable after some time.
For example , middle-aged Type A men displayed significant correlations over a 3-month interval on the competitive effect time task (Sherwood ain al., 1999). Kamarck ainsi que al. (2000) identified myocardial and vascular responders inside the initial assessment session, and this tendency was stable after having a 4-week span. Thus, there is certainly evidence that hemodynamic single profiles may be fairly stable throughout tasks and across period, i. electronic., some individuals may well respond within a relatively even more myocardial/vascular method to diverse tasks, and this response may possibly tend to end up being stable as time passes.
What are the factors that may influence a person’s hemodynamic response pattern? Previous research suggested that ethnicity may be one of these types of factors since African American individuals typically have an inclination to respond in a vascular method; in addition , there are significant gender differences (Allen, Stoney, Owens, & Matthews, 1999). However , there is little research within the personality elements that might influence hemodynamic style of answering. Cooper and Waldstein (2004) found that hostility was associated with better TPR.
Cacioppo and colleagues (2002) and Hawkey, Burleson, Berntson, & Cacioppo (2003) found that in adults, loneliness was associated with larger TPR and lower COMPANY, whereas non-lonely young adults got higher COMPANY. Tomaka and colleagues (Tomaka et al., 1999) found that strategy motivation was associated with larger CO. However , these two studies looked at the state variables, including loneliness and approach/avoidance inspiration. It might be appealing to investigate the result of stable personality traits as well.
Previous research has documented the health-enhancing and health reducing effect of numerous personality factors, such as confidence (Carver & Scheier, 2001), Type A, and hardiness (Maddi, 1999) in terms of stress and foreseeable future risk for hypertonie and CVD development. Yet, there has been very little research examining the effect of personality factors on the hemodynamic mechanisms fundamental BP reactivity. Blascovich and colleagues (2003) emphasized the need for research making clear the effect of social and emotional elements on the patterns of physiological response linked to challenge and threat appraisals.
HPA Reactivity in Response to fret Situations Evoking HPA Service HPA response is elicited by the conditions implying significant threat for the individual, including physical survival (Sapolsky et al., 2000) and menace to a person’s important desired goals (Carver & Scheier, 1999). Cortisol allows the affected person manage immediate metabolic demands of the situation. Although cortisol response could possibly be elicited by a variety of conditions, it is the threat to a person’s important goals that triggers this response. Dickerson and Kemeny (2004) conducted meta-analysis of 208 research on cortisol reactivity.
The effect size present in these studies varied from small (d=. 20) to fairly significant (d=. 87) depending on the experimental task. The greatest effect sizes were made by tasks that involved unrestrainable threat to social do it yourself, such as public speaking, coupled with nuisance, false reviews, perceived lack of ability to full the task, etc . (d =. 92). Hence, it appears that cortisol response to an acute lab stressor is most likely to be elicited by the uncontrollable social-evaluative tasks. These two features of uncontrollability and social evaluation have regularly been found to produce strong distress.
Uncontrollability is one of the time-honored characteristics identifying stressful scenarios. In a traditional study, Glass and Musician (1973) showed that anxiety is linked to the situations concerning uncontrollability and unpredictability. Social evaluation and self-presentation are common features of everyday routine. In the experience of daily tension, interpersonal events play a central role, self-presentation is concerned with (1) one’s ought to define a person’s social home, and produce one’s sociable self since close as it can be to a person’s ideal home; and (2) one’s need to please the group (Baumeister, 1982).
This ought to make a favorable impression is important for most people, and when they hesitation that they be successful, people experience social stress marked by simply feelings of apprehension, self-consciousness, and distress. Social anxiousness may be a dominant aspect in modern life. Therefore, an unmanageable social-evaluative menace may produce intense connection with distress noticeable by significant cortisol elevation. The Relationship among Joint SAM and HPA axes Service and Character
The research looking into joint HPA and MIKE axes service in response to stress indicated which a single manipulation of the fresh task may well elicit several patterns of SAM and HP A response. For example , Earle, Linden, and Weinberg (1999) compared individuals performing mental arithmetic job in front of an audience in nuisance and no-harassment conditions. Nuisance consisted of the scripted transactions by same-gender experimenters. Both conditions produced sympathetic activation in terms of DBP (in men) and HUMAN RESOURCES (in women), but it was the harassment condition only that produced significant cortisol elevation.
The research on the relationship between joint HPA and MIKE axes service and individuality dispositions during a single contact with stress identified a link between personality and SAM reactivity, but not between personality and HPA reactivity. This obtaining pertains to the studies including single experience of an acute laboratory stressor. For example , Taylor et approach. (2003) discovered that high self-enhancers got lower sympathetic responses (SBP and HR), but writers did not locate a significant difference in eortisol response to stress between the high and low self-enhancers. Gregg et al.
(1999) did not discover any important correlations among eortisol and hemodynamic procedures in the members performing mental arithmetic task and chilly pressor job. Schommer, Kudielka, Hellhammer, and Kirschbaum (1999) found no relationship between eortisol response to an serious laboratory stressor and the nature of Extraversion, Neuroticism, or perhaps Psychoticism assessed with the Eysenck Personality Questionnaire-Revised. However , the investigation evidence with regards to the effect of exposure to repeated psychosocial pressure did find a tremendous effect of persona on cortisol reactivity.
Pruessner, Gaab, Hellhammer, Lintz, Schumer, and Kirschbaum (1999) revealed the individuals to psychological stressor (public speaking) over a period of 5 successive days. Even though during the first day, there was no significant relationship between personality elements (locus of control) and cortisol response, there was a substantial relationship among locus of control and cortisol response later, via day two to working day five. Pruessner et ing. (1999) discovered that the combination of data obtained over the five consecutive days and nights was essential to detect the significant effect of personality traits, such as locus of control, on cortisol reactivity.
Within study, Kirschbaum, Prussner, Natural stone, Federenko, Gaab, Lintz, Schommer, and Hellhammer (1999) looked into cortisol respond to the repeated psychosocial stressor consisting of public speaking and mental arithmetic in a group of healthy young adults. The participants had been exposed to the stressor pertaining to 5 days and nights. Kirschbaum and colleagues (1999) observed quick habituation with the HPA axis in some members. These “low cortisol responders exhibited large cortisol replies during the first day, and then this response subsided during the 5-day interval.
However , in certain participants, the HPA axis did not habituate to the stressor. These “high responders stored producing significant cortisol reactions throughout the entire 5-day period. The tendency to exhibit persistent excessive cortisol responses to repeated psychological stress was highly associated with several personality factors, such as having lower self-esteem, viewing yourself as significantly less attractive than others, and being more regularly in depressed mood, and lower extraversion. Cortisol large responders likewise reported much more symptoms of stress than cortisol low responders.
In another study, Schommer, Hellhammer, and Kirschbaum (2003) also found a group of people who have persistent cortisol response to psychological stress. In addition , high cortisol responders got significantly bigger plasma ACTH levels. This kind of study likewise looked at the sympathetic activation. The outcomes suggested that SAM axis does not habituate to the repeated stress, while rapidly while the HPA axis really does, because the levels of catecholamines (epinephrine and norepinephrine) were consistently elevated in both everywhere cortisol responders. Pruessner ainsi que al.
(1999) suggested that during the initial exposure to anxiety, the effect of personality upon HPA reactivity is masked by the originality of the condition. Novelty, which is one of the traditional features defining a stressful condition, has a profound effect on HPA reactivity hiding moderating a result of personality. Nevertheless , during the second and succeeding exposures to stress, the uniqueness is reduced, so the affect of personality dispositions might be investigated. Conversation and Conclusion According to the biopsychosocial model, challenge and threat response are evoked just by the situations involving “motivated performance (Seery at approach.
, 2004). Diamond in the activity is essential in eliciting both challenge and threat reactivity. The task needs to be “goal-relevant (e. g., it ought to be important for the participant). Hardiness, especially the commitment and control elements, can be significantly correlated with conscientiousness, and both dispositions happen to be associated with greater TPR increase in response to pressure and minimum change in CO. Higher conscientiousness, commitment for the task and need to control the situation might lead to the greater diamond in the process and larger expectations to get the quality of a person’s performance.
This may have ended in greater unfavorable affectivity regarding the task and about one’s performance. In contrast, the low-hardy individuals can be almost certainly disengaged, and, therefore , confirmed less reactivity. Due to the better commitment to the task, high-hardy individuals confirmed a response account that overstated the response typically evoked by the process. Thus, in a socially evaluative situation known to evoke a very good threat hemodynamic response profile, greater hardiness may be associated with greater menace response.
This kind of tendency might be due to the greater commitment towards the task and greater ought to control the problem. To fully be familiar with effect of hardiness on psychophysiology of individual stress answering, the HPA reactivity should be evaluated (Seery et ‘s., 2004). Hardiness can be linked to a tendency towards exaggerated cardiovascular system response to the psychosocial stressor. The general routine of reactivity evoked by TSST can be consistent with the menace profile. It will be interesting to check into reactivity to the stressor that evokes primarily challenge hemodynamic response account.
According to the biopsychosocial model, concern and menace are defined by the ratio of the demand posed by the case and perceived resources to deal with it (Blascovich et ing., 2003). Hence, in the tough situation, the individuals would perceive even more resources to deal with the demand. Due to the greater determination to the task and greater conscientiousness, high-hardy individuals might show better challenge reactivity. However , it can possibly be possible that high-hardy individuals will have greater issues about their performance, which may be connected with greater relax reflected within a threat response profile.
In conclusion, it appears that in a few individuals, the HPA axis cannot conform quickly to the repeated demanding situation, so these individuals keep responding with high cortisol elevations consistently. There is hyperlink between personality dispositions (locus of control, self-esteem, and extraversion) which persistent high cortisol response. In conclusion, the research suggests that though a single experience of stress might provide information about the relationship among personality and SAM reactivity, the HPA activation will never be tapped.
In order to obtain a true picture of joint SAM and HPA activation, you ought to consider the effect of repeated exposure to psychological stress. Referrals Allen, Meters. T., Stoney, C. M., Owens, J. F., & Matthews, K. A. (1993). Hemodynamic alterations to laboratory stress: the influence of gender and personality. Psychosomatic Medicine, fifty-five (6), 505-17. Baumeister, L. F. (1982). A self-presentational view of social trends. Psychological Bulletins, 91(1), 3-26 Beasley, Meters., Thompson, Capital t., Davidson, M. (2003) Strength in response to life stress: The effects of coping design and cognitive hardiness.
Personality and Individual Differences, thirty four (1), 77-95. Berkman, T. F. & Syme, T. L. (1979). Social networks, sponsor resistance, and mortality: a nine-year girl study of Alameda Region residents. American Journal of Epidemiology, 109 (2), 186-204. Blascovich, L., Mendes, T. B., Seeker, S. M. & Salomon, K. (1999). Social ‘Facilitation’ as Problem and Menace. Journal of Personality and Social Psychology, 77(1), 68-77. Blascovich, T., Mendes, W. B., Tomaka, J., Salomon, K., & Seery, Meters. (2003). The robust mother nature of biopsychosocial model problem and risk: A reply to Wright and Kirby.
Personality and Cultural Psychology Review, 7 (3), 234-243. Boden-Albala, B, Litwak, E, Elkind, M. H., Rundek, Big t., & Sacco, R. T. (2005) Cultural isolation and outcomes content stroke. Neurology, 64(11), 1888-92. Cacioppo, J. T., Hawkley, L. C., Crawford, L. E., Ernst, J. M., Burleson, M. H., Kowalewski, R. M., Malarkey, Watts. B., Truck Cauter, Elizabeth., & Berntson, G. G. (2002). Solitude and wellness: potential systems. Psychosomatic Medicine, 64 (3), 407-17. Carver, C. S i9000., & Scheier, M. Farreneheit. (2001). Optimism, pessimism, and self-regulation.
In E. C. Chang (Ed. ), Confidence and pessimism: Implications intended for theory, analysis, and practice (pp. 31-51). Washington, DC: American Psychological Association. Cooper, D. C., & Waldstein, S. Ur. (2004). Hostility differentially anticipates cardiovascular risk factors in African American and White young adults. Journal of Psychosomatic Analysis, 57 (5), 491-9. Costanzo ES, Lutgendorf SK, Sood AK, Anderson B, Sorosky J, Lubaroff DM. Psychological factors and interleukin-6 among women with advanced ovarian malignancy. Cancer june 2006; 104: 305-13.
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