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This chapter outlines the ways in which depression and other mental health issues influence adherence and health-behavior change. Patient adherence and health-behavior change are defined and described. Common mental health issues including depression and anxiety are described as well as the prevalence of nonadherence to treatment for these conditions. Next, comorbidity of physical and mental health issues are discussed, such as depression co-occurring with various chronic diseases, providing evidence of the effects of mental health on adherence and health-behavior change. The mechanisms for the relationship of mental health to adherence and health-behavior change are discussed through the framework of the information-motivation-strategy model, with adherence being affected due to cognitive factors, motivational factors, and resource-related factors. The chapter concludes with a discussion of what health-care professionals can do to address and reduce this barrier to adherence and health-behavior change.

This chapter provides an overview of how emotions can contribute to poorer health among stigmatized populations. First, it describes some of the primary affective responses that stigmatized individuals might experience, including externalizing emotions, uncertainty, and anxious affect. These affective responses can occur as a result of interacting with individuals who display subtle or overt signs of bias or perceiving a system as unfair, or they can occur from expectations based on prior experiences that shape perception. Second, this chapter reviews how these affective states may alter underlying biological processes to directly influence health. Finally, it examines indirect pathways whereby emotion processes potentiate health-damaging behaviors, such as poor eating habits, restless sleep, excessive alcohol and drug abuse, and risky behavior. Overall, research in this area suggests that affective experiences resulting from stigmatization can change biology and behavior in ways that can ultimately lead to poor health.

Affiliation with others is a basic human coping response for managing a broad array of stressful circumstances. Affiliating with others is both psychologically and biologically comforting, and biologically may depend upon oxytocin and brain opioid pathways. The origins of affiliative responses to stress include early life experiences, genetic factors, and epigenetic processes that interact with the availability of supportive others during times of stress. The beneficial consequences of affiliation for mental and physical health are strong and robust. Future research will continue to clarify the underlying biopsychosocial pathways that explicate why this is the case.

The clinical settings in which physicians and other healthcare providers must apply their scientific knowledge and technical expertise are diverse and require further adaptive capacities on their part. Thus, the science and the art, although often opposed, are in fact complementary and together define excellence in practice in which the art is not, as stated by Saunders, merely part of the medical humanities but it is integral to medicine as an applied science. This essay addresses those dimensions of medical talk described as the “art” of the medical encounter, how these impact the quality of information gathering and provision, and how, in turn, this influences patients’ understanding and recall. The notion of the “art of information exchange” is reframed as a “medical dialogue” using communication skills and dimensions not traditionally thought of when referring to the “art” of medical information exchange.

Inflammation is acknowledged as a risk factor for the onset and development of cardiovascular disease (CVD). This has led some to hypothesize that inflammation is a possible mechanism that may mediate, in part, the relation of CVD to factors associated with increased CVD risk—hostility, anger, and depression. This chapter reviews the empirical evidence of the associations between biomarkers of inflammation and hostility, anger and depression, alone and in combination. Before doing so, I present a brief description and review of the role of inflammation in disease development and the methods used to measure inflammation at point-of-care and in research laboratories. Lastly, I review preliminary data suggesting that gender and adiposity may potentially mediate and moderate the relationship between depression and inflammation.

We present a wide array of evidence that suggests that the presence of positive affect (PA) may be associated with a variety of health outcomes. Current evidence indicates that PA is connected to longer life, lower incidence of disease, better recovery from disease, and overall better health. While the research has not conclusively determined the mechanisms that link these concepts, we review evidence that examines the various connections between PA and health to shed light on how they may interact. We also provide suggestions for future research in this area, such as focusing on the roles that specific emotions, culture, and technology may play in the relationship between PA and health. This chapter highlights foundational evidence that indicates high levels of PA are associated with better health and provides creative directions for new research within this field to take.

Nonadherence represents a significant challenge not only to personal health and well-being but also to the health-care system as a whole. The Information-Motivation-Strategy model, which forms the organizational framework for this volume, provides a simple yet comprehensive heuristic for addressing the significant and complex problem of nonadherence, emphasizing within each component the vital role of communication between the clinician and patient.

In this chapter I will discuss the theoretical origins of benefit-finding and sense-making. In particular, proposals as to how these two meaning-making processes might fit into the stress and coping framework will be examined (Lazarus & Folkman, 1984; Park & Folkman, 1997). Research that has examined the measurement, nature, and role of benefit-finding and sense-making in coping with chronic illness will be reviewed. The interpersonal context of sense-making and benefit-finding will also be considered, particularly the role of shared meaning-making within patient–caregiver dyads. Although the body of research investigating benefit-finding in chronic illness is growing, the role of sense-making has been neglected, as has consideration of the joint role of these two related meaning-making processes. The implications of sense-making and benefit-finding research outcomes for interventions designed to promote health and quality of life in people with chronic illness will be discussed. Finally, future research directions will be delineated.

This chapter focuses on how communication is affected when, in addition to the physician and the patient, there is another individual present during the interaction. Although it is difficult to estimate the frequency with which triadic (three-person) encounters take place, they occur in a variety of medical situations, including pediatric, obstetric, geriatric, and oncology visits, visits in which an interpreter is present, visits in which health-care professional trainees participate, and a myriad of inpatient situations. Although estimates of the frequency of accompaniment to medical visits vary from study to study, we hypothesize that over the next decade there will be many more encounters in which a third person is present. This is likely to occur because of the rapid growth of the aging of the population (where there is frequent accompaniment in geriatric visits), the greater recognition of medical errors (and the potential role that accompanying third parties may play in reducing errors), the increasing size of the immigrant population that will need translating services, and the consumerist approach to health care. Of note, in recent empirical research, we have observed tetradic (four-person) and pentadic (five-person) medical visits. In this chapter, we briefly review the theoretical basis for understanding multiparty medical encounters (i.e., visits in which more than two interactive participants are present) and examine triadic interactions in four clinical areas: pediatric care, oncologic care, encounters with interpreters present, and geriatric care. We also provide an excerpt of a transcript from a visit to explore interactions in which more than three persons are present. An agenda for future research is suggested.

This chapter reviews the construct of biculturalism, focusing on individuals with multiple cultural backgrounds. The chapter focuses on biculturalism as a heterogeneous label, and it covers several variants of biculturalism that have been studied. A number of biculturalism-related constructs are discussed, including endorsement of two or more cultural streams, cultural frame switching, bicultural identity integration, globalization-based biculturalism, and triculturalism (endorsement of three or more cultural streams). Distinctions between biculturalism and triculturalism are discussed, along with consideration of situations in which more than three cultural streams may be intersecting. The chapter concludes with a section on practical implications of biculturalism and on interventions to promote biculturalism in individuals and families.

This chapter presents a theoretical framework that highlights the role of social cognition in mediating the effects of discrimination on health. This framework suggests that through alterations in schemas and appraisal processes, long-term discrimination increases the experienced frequency, intensity, and duration of threat exposure and concomitant distress. At the same time, the ability to recover from threat exposure may be impaired by the effects of discrimination on cognitive control processes that are necessary for modulating stress responses. Together, these processes may influence the ability to initiate and sustain health-promoting behavior, avoid health-impairing behavior, attenuate stress reactivity, and facilitate stress recovery. Through effects on social cognition, persistent exposure to discrimination may potentiate sustained dysregulation of psychophysiological systems responsible for maintaining health.

Despite the central importance of satisfaction with one’s physical appearance to overall psychological well-being, very little research has investigated how body image is related to identity construction, a key developmental task for young people. This chapter discusses theories on body image that the authors believe have utility in studying the relation between body image and identity because they encompass both sociocultural norms about appearance and one’s self-perceptions and self-evaluations about the body. The authors then outline several factors that may be relevant to body image and identity formation including gender, biological factors, social group factors, and sociocultural factors. In the conclusion, the authors briefly highlight main points and offer some ideas for future research on this important and emerging area of inquiry.

Understanding the limits on age-graded improvements or stability in emotional well-being may provide insights into the mechanisms that drive health-related individual differences in adulthood. Insights from daily diary and experience sampling studies highlight some boundary conditions for preserved emotional well-being and regulation in older adults, suggesting that the widely accepted “aging paradox” of increasing well-being and positive affect may not be universally correct; a late-life reduction in positive affect and an increase in negative affect may be tied to end-of-life processes. Experience sampling studies also suggest that older adults are likely to experience negative affect when confronted with everyday stressors, and it is unclear whether age is associated with increases or decreases in negative affect in this situation. Chronic exposure to stress, coupled with difficulty regulating emotional reactions to unavoidable stressors, may have long-term negative consequences for older adults’ psychological well-being.

Volumes of research and countless models have examined how people decide to make a health-behavior change. This chapter is focused on what happens after the decision to change is made. Do people maintain the changes they initiate? In other words, how do people commit to the new healthier behavioral choice? Often, the factors that push a person to make the change may be the same factors that help the person maintain the change. We discuss how, in fact, there may be a paradoxical inverse relationship. A number of theories are examined and applied to behavior maintenance. These include borrowing from both the commitment literature with Rusbult’s Investment Model of Commitment, as well as the health-behavior-change literature, such as the Theory of Planned Behavior, the Health Belief Model, and the Transtheoretical Model. We also examine the concepts of approach and avoidance motivation and goal orientation. Discussion of these models and future directions conclude this chapter.

Social anxiety disorder (SAD) and major depressive disorder (MDD) are prevalent disorders that exhibit a high rate of co-occurrence. Furthermore, these disorders have been shown to be associated with each other, suggesting that the presence of one disorder increases risk for the other disorder. In this chapter, we discuss relevant theories that attempt to explain why SAD and MDD are related. We propose that the available evidence provides support for conceptualizing the comorbidity of SAD and MDD as resulting from a shared underlying vulnerability. There is evidence that this underlying vulnerability is genetic in nature and related to trait-like constructs such as positive and negative affect. We also discuss the possibility that the underlying vulnerability may confer tendencies toward certain patterns of thinking. Finally, we discuss theories that propose additional causal pathways between the disorders such as direct pathways from one disorder to the other. We advocate for a psychoevolutionary conceptualization that links the findings on the underlying cognitions to the shared relation of lower positive affect and the findings on peer victimization. We suggest that, in addition to a shared underlying vulnerability, the symptoms of social anxiety and depression may function as a part of a behavior trap in which attempts to cope with perceived social exclusion lead to even higher levels of social anxiety and depression. Finally, we make recommendations for the best methods for assessing SAD and MDD as well as suggestions for treating individuals with both disorders.

Immune-behavioral interactions are widespread throughout the animal kingdom. For example, decreased feeding after immune activation is common in animals. Work with insects suggests that changes in feeding behavior during an immune response (e.g., illness-induced anorexia) may be a behavioral method of biasing multifunctional physiological pathways toward immune function. Work on insects also suggests that stress hormones help to reconfigure the immune system in order to optimize its performance during the physiological shifts required for “flight-or-fight.” The effects of stress hormones on immune function appear maladaptive only when compared to what the animal could do under optimal conditions. Work with insects also cautions against overly simplistic interpretations of immune assay results. A comparative approach to psychoneuroimmunology will increase our understanding of the adaptive function of immune-behavioral interactions. Understanding why these connections exist is of both practical and theoretical importance.

Conservation of resources (COR) theory has become one of the two leading theories of stress and trauma in the past 20 years, along with the pioneering theory of Lazarus and Folkman (1984). COR theory emphasizes objective elements of threat and loss, and common appraisals held jointly by people who share a biology and culture. This places central emphasis on objective reality and greater focus on circumstances where clear stressors are occurring, rather than a focus on personal appraisal. Although originally formulated to focus on major and traumatic stress, COR theory has also become a major theory in the field of burnout and the emerging field of positive psychology. This chapter reviews the principles of COR theory and covers new ground by examining more closely aspects of resource gain cycles and how they might contribute to resilience.

Research in the past few decades has demonstrated that positive affect co-occurs with negative affect in the context of stressful life events, has unique beneficial consequences, and may be a useful focus of intervention. The purpose of this chapter is to provide an overview of the variety of single- and multiple-component interventions that hold promise for increasing positive affect for people experiencing serious life stress. The research shows that positive affect interventions are feasible, acceptable, and in many cases efficacious and that many different approaches hold promise for increasing positive affect. The field is relatively new, however. Future work should test these approaches in more applied settings to determine whether the findings can be translated into the “real world” with all its attendant constraints, challenges, and complexities.

Although bereavement is a normal part of life, it is associated with detrimental mental and physical health consequences and is thus an important topic in the context of stress, coping, and health. Research on the relationship between bereavement and physical and mental health is reviewed. Ways that persons cope are likely to interact with diverse risk factors (circumstances of death, intra- and interpersonal variables, etc.) to co-determine excesses in ill health or poor adaptation. Thus, close attention is given to empirical and theoretical contributions to understanding the relative effectiveness of different coping strategies. In addition to summarizing the state of knowledge in the field in the above areas, new directions for the field are considered.

Although the medical treatment of HIV has improved dramatically since the introduction of effective antiretroviral treatment, people with HIV still face an enormous number of stressors. This chapter reviews the ways of coping that people with HIV use, and the effectiveness of these strategies. It is divided into four primary sections: coping and physical health, coping and psychological health, spiritual coping and physical health, and spiritual coping and mental well-being. There is evidence for the effectiveness of approach coping strategies such as active coping and proactive behavior, maintaining a fighting spirit, and planful problem-solving; for cognitive coping strategies such as positive reappraisal, finding meaning, and optimism; for more enduring personality coping styles, such as extraversion, openness, emotional expression, and altruism; and finally for spirituality. Research findings for the effectiveness of social support are mixed, though it appears to be most helpful as the disease advances. Finally, there is substantial evidence that avoidant coping has a detrimental effect on health and well-being. Clinical recommendations are discussed, including use of the Folkman and Lazarus strategy that matches problem-focused coping with changeable aspects of stressors and emotion-focused coping with unchangeable stressors, and introducing a functional component framework that expands the Folkman and Chesney view (Coping Effectiveness Training [CET]) to include a focus on changeable and unchangeable aspects of the self and the reaction to the stressor in addition to the CET focus on changeable and unchangeable aspects of the stressor alone. In addition, we recommend that emotion-focused coping be broken down into its component parts for clinical purposes: cognitive (reframing, positive outlook), emotion-focused activities to improve mood (relaxation, meditation, exercise), and emotional expression, spirituality, and substance use. Future directions are presented, including preliminary qualitative work from our group. The chapter ends with a summary and clinical suggestions.