title: Emotional expression and depth processing of trauma and their relation to long-term survival in patients with HIV/AIDS.
abstract: OBJECTIVE
  This study examined the relationship between emotional expression and depth processing of trauma and long-term survival of patients living with AIDS. A further purpose was to examine the immune, health behavior and psychosocial correlates of emotional disclosure and depth processing.
  
  
  METHODS
  Subjects wrote essays describing their reactions to past traumas; these were scored for emotional expression and depth processing (positive cognitive appraisal change, experiential involvement, self-esteem enhancement and adaptive coping strategies). Two HIV-seropositive groups were recruited for this study; long-term survivors (LTS; n=46) patients who had survived at least 4 years past a Category C (AIDS defining) symptom prior to starting protease inhibitors and an equivalent HIV-seropositive comparison group (ECOMP(LTS); n=89) who had CD4+ cells between 150 and 500, and had no history of Category C symptoms. The groups were equivalent on age, gender, ethnicity, education, employment, income, sexual orientation and route of infection.
  
  
  RESULTS
  The group LTS were significantly higher than the ECOMP(LTS) group on emotional expression and depth processing. Depth processing mediated the relationship between emotional expression and long-term survival status. Depth processing was positively related to CD4+ cell number for women. Emotional expression was also significantly related to viral load (negatively) and to CD4+ cell number (positively) for women only. Interestingly, only depth processing (and not emotional expression) was related to medication adherence and to psychosocial variables (perceived stress and social support).
  
  
  CONCLUSIONS
  Emotional expression and depth processing were related to long-term survival, however, depth processing was the mediator for this relationship and only depth processing was associated with medication adherence, perceived stress and social support. Our results underscore the importance of depth processing (and not just emotional expression) of traumatic experiences for people living with HIV/AIDS.
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, FL 33124, USA. c.ocleirigh@umiami.edu
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.forename: Michael
authors.initials: M
authors.lastname: Antoni
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Fletcher
authors.forename: Lisa
authors.initials: L
authors.lastname: McGuffey
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Balbin
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
authors.forename: George
authors.initials: G
authors.lastname: Solomon
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology*; D000223:Adaptation, Psychological; D000328:Adult; D019260:Expressed Emotion; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D012944:Social Support; D013315:Stress, Psychological; D017741:Survivors / Q000523:psychology*; D014947:Wounds and Injuries / Q000523:psychology*