Annals of Behavioral Medicine

, Volume 25, Issue 2, pp 146–155 | Cite as

Finding positive meaning and its association with natural killer cell cytotoxicity among participants in a bereavement-related disclosure intervention

  • Julienne E. BowerEmail author
  • Margaret E. Kemeny
  • Shelley E. Taylor
  • John L. Fahey


This study tested the hypothesis that cognitive processing about a past bereavement would produce increases in goals and priorities indicative of finding positive meaning from the loss. It was further hypothesized that increases in meaning-related goals would be associated with changes in immune function, specifically increased natural killer cell cytotoxicity (NKCC). Cognitive processing was manipulated using written emotional disclosure. Forty-three women who had lost a close relative to breast cancer wrote about the death (cognitive processing/disclosure group) or about nonemotional topics weekly for 4 weeks. Contrary to predictions, written disclosure did not induce changes in meaning-related goals or NK cell parameters. However, women in both experimental groups who reported positive changes in meaning-related goals over the study period also showed increases in NKCC. Results suggest that prioritizing goals emphasizing relationships, personal growth, and striving for meaning in life may have positive biological correlates but that solitary written disclosure may not be sufficient to induce changes in these goals in response to a past bereavement.


Behavioral Medicine Life Goal Natural Killer Cell Cytotoxicity Positive Meaning Intrinsic Goal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. (1).
    Herbert TB, Cohen S: Stress and immunity in humans: A meta-analytic review. Psychosomatic Medicine. 1993, 55:364–379.CrossRefPubMedGoogle Scholar
  2. (2).
    Janoff-Bulman R, Frantz CM: The impact of trauma on meaning: From meaningless world to meaningful life. In Power M, Brewin C (eds), The Transformation of Meaning in Psychological Therapies. London: Wiley, 1997.Google Scholar
  3. (3).
    Taylor SE: Adjustment to threatening events:Atheory of cognitive adaptation. American Psychologist. 1983, 41:1161–1173.CrossRefGoogle Scholar
  4. (4).
    Tedeschi RG, Calhoun LG: Trauma and Transformation: Growing in the Aftermath of Suffering. Thousand Oaks, CA: Sage, 1995.CrossRefGoogle Scholar
  5. (5).
    Park CL, Folkman S: Meaning in the context of stress and coping. Review of General Psychology. 1997, 1:115–144.CrossRefGoogle Scholar
  6. (6).
    Davis CG, Nolen-Hoeksema S, Larson J: Making sense of loss and benefiting from the experience: Two construals of meaning. Journal of Personality and Social Psychology. 1998, 75:561–574.CrossRefPubMedGoogle Scholar
  7. (7).
    Bower JE, Kemeny ME, Taylor SE, Fahey JL: Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV seropositive gay men. Journal of Consulting and Clinical Psychology. 1998, 66:979–986.CrossRefPubMedGoogle Scholar
  8. (8).
    Schwartzberg SS: Struggling for meaning: How HIV-positive gay men make sense of AIDS. Professional Psychology: Research and Practice. 1993, 24:483–490.CrossRefGoogle Scholar
  9. (9).
    Updegraff JA, Taylor SE, Kemeny ME, Wyatt GE: Positive and negative effects of HIV-infection in women with low socioeconomic resources. Personality and Social Psychology Bulletin. 2002, 28:382–394.CrossRefGoogle Scholar
  10. (10).
    Taylor SE, Lichtman RR, Wood JV: Attributions, beliefs about control, and adjustment to breast cancer. Journal of Personality and Social Psychology. 1984, 46:489–502.CrossRefPubMedGoogle Scholar
  11. (11).
    Andrykowski MA, Brady MJ, Hunt JW: Positive psychological adjustment in potential bone marrowtransplant recipients: Cancer as a psychosocial transition. Psycho-Oncology. 1993, 2:261–276.CrossRefGoogle Scholar
  12. (12).
    Tennen H, Affleck G, Mendola R: Causal explanations for infertility: Their relationship to control appraisals and psychological adjustment. In Stanton A, Dunkel-Schetter C (eds), Infertility: Perspectives From Stress and Coping Research. New York: Plenum, 1991, 109–132.CrossRefGoogle Scholar
  13. (13).
    Affleck G, Tennen H, Croog S, Levine S: Causal attributions, perceived benefits, and morbidity after a heart attack: An 8-year study. Journal of Consulting and Clinical Psychology. 1987, 55:29–35.CrossRefPubMedGoogle Scholar
  14. (14).
    Thompson SC: The search for meaning following a stroke. Basic and Applied Social Psychology. 1991, 12:81–96.CrossRefGoogle Scholar
  15. (15).
    Cruess DG, Antoni MH, McGregor BA, et al.: Cognitive-behavioral stress management reduces serum cortisol by enhancing benefit finding among women being treated for early stage breast cancer. Psychosomatic Medicine. 2000, 62:304–308.CrossRefPubMedGoogle Scholar
  16. (16).
    Greenberg MA: Cognitive processing of trauma: The role of intrusive thoughts and reappraisals. Journal of Applied Social Psychology. 1995, 25:1262–1296.CrossRefGoogle Scholar
  17. (17).
    Horowitz MJ: Stress Response Syndromes (2nd ed.). New York: Aronson, 1986.Google Scholar
  18. (18).
    Calhoun LG, Cann A, Tedeschi RG, McMillan J: A correlational test of the relation between posttraumatic growth, religion, and cognitive processing. Journal of Traumatic Stress. 1999, 13:521–527.CrossRefGoogle Scholar
  19. (19).
    Pennebaker JW: Writing about emotional experience as a therapeutic process. Psychological Science. 1997, 8:162–166.CrossRefGoogle Scholar
  20. (20).
    Esterling BA, Antoni MH, Fletcher MA, Margulies S, Schneiderman N: Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titers. Journal of Consulting and Clinical Psychology. 1994, 62:130–140.CrossRefPubMedGoogle Scholar
  21. (21).
    Pennebaker JW, Kiecolt-Glaser JK, Glaser R: Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology. 1988, 56:239–245.CrossRefPubMedGoogle Scholar
  22. (22).
    Petrie KJ, Booth RJ, Pennebaker JW, Davison KP, Thomas MG: Disclosure of trauma and immune response to a hepatitis B vaccination program. Journal of Consulting and Clinical Psychology. 1995, 63:787–792.CrossRefPubMedGoogle Scholar
  23. (23).
    Pennebaker JW, Beall SK: Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology. 1986, 95:274–281.CrossRefPubMedGoogle Scholar
  24. (24).
    Kelley JE, Lumley MQ, Leisen JCC: Health effects of emotional disclosure in rheumatoid arthritis patients. Health Psychology. 1997, 16:331–340.CrossRefPubMedGoogle Scholar
  25. (25).
    Smyth JM, Stone AA, Hurewitz A, Kaell A: Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. Journal of the American Medical Association. 1999, 281:1304–1309.CrossRefPubMedGoogle Scholar
  26. (26).
    Pennebaker JW, Mayne TJ, Francis ME: Linguistic predictors of adaptive bereavement. Journal of Personality and Social Psychology. 1997, 72:863–871.CrossRefPubMedGoogle Scholar
  27. (27).
    Zakowski SG, Valdimarsdottir HB, Bovbjerg DH, et al.: Predictors of intrusive thoughts and avoidance in women with family histories of breast cancer. Annals of Behavioral Medicine. 1997, 19:362–369.CrossRefPubMedGoogle Scholar
  28. (28).
    Bovbjerg DH, Valdimarsdottir HB: Interventions for healthy individuals at familial risk for cancer: Biobehavioral mechanisms for health benefits. In Baum A, Anderson B (eds), Psychosocial Interventions for Cancer. Washington, DC: American Psychological Association, 2001.Google Scholar
  29. (29).
    Whiteside TL, Herberman RB: The role of natural killer cells in human disease. Clinical Immunology and Immunopathology. 1989, 53:1–23.CrossRefPubMedGoogle Scholar
  30. (30).
    Strayer DR, Carter WA, Brodsky I: Familial occurrence of breast cancer is associated with reduced natural killer cytotoxicity. Breast Cancer Research and Treatment. 1986, 7:187–192.CrossRefPubMedGoogle Scholar
  31. (31).
    Futterman AD, Kemeny ME, Shapiro D, Fahey JL: Immunological and physiological changes associated with induced positive and negative mood. Psychosomatic Medicine. 1994, 56:499–511.CrossRefPubMedGoogle Scholar
  32. (32).
    Fawzy FI, Kemeny ME, Fawzy NW, et al.: A structured psychiatric intervention for cancer patients: Changes over time in immunological measures. Archives of General Psychiatry. 1990, 47:729–735.CrossRefPubMedGoogle Scholar
  33. (33).
    Kiecolt-Glaser JK, Glaser R, Williger D, et al.: Psychosocial enhancement of immunocompetence in a geriatric population. Health Psychology. 1985, 4:25–41.CrossRefPubMedGoogle Scholar
  34. (34).
    Carver CS, Scheier MF: On the Self-Regulation of Behavior. New York: Cambridge University Press, 1998.CrossRefGoogle Scholar
  35. (35).
    Kemeny ME, Gruenewald T: Affect, cognition, the immune system and health. In Mayer EA, Saper C (eds), The Biological Basis for Mind Body Interactions: Progress in Brain Research Series. Amsterdam: Elsevier Science B.V., 2000, 291–308.Google Scholar
  36. (36).
    Cole SW: Negative physical health effects of psychological inhibition in disclosure study control groups. Manuscript submitted for publication.Google Scholar
  37. (37).
    Smyth JM: Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology. 1998, 66:174–184.CrossRefPubMedGoogle Scholar
  38. (38).
    Kemeny ME: The Life Goals Inventory. Unpublished manuscript.Google Scholar
  39. (39).
    Kemeny ME, Reed G, Taylor SE, Visscher B, Fahey JL: Negative HIV-specific expectancies predict immunological evidence of HIV progression. Unpublished manuscript.Google Scholar
  40. (40).
    Kemeny ME, Dickerson S, Gruenewald T, Bower J, Lu Q: Validation of a measure of life goals and priorities. Unpublished manuscript.Google Scholar
  41. (41).
    Radloff LS: The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement. 1977, 1:386–401.CrossRefGoogle Scholar
  42. (42).
    Faschingbauer TR, Zisook S, DeVaul R: The Texas Revised Inventory of Grief. In Zisook S (ed), Biopsychosocial Aspects of Bereavement. Washington, DC: American Psychiatric Press, 1987, 109–128.Google Scholar
  43. (43).
    Kiecolt-Glaser JK, Glaser R: Methodological issues in behavioral immunology research with humans. Brain, Behavior, and Immunity. 1988, 2:67–78.CrossRefPubMedGoogle Scholar
  44. (44).
    Stanton AL, Danoff-Burg S, Sworowski LA, et al.: Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients. Journal of Clinical Oncology. 2002, 20:4160–4168.CrossRefPubMedGoogle Scholar
  45. (45).
    Range LM, Kovac SH, Marion MS: Does writing about bereavement lessen grief following sudden, unintentional death? Death Studies}. 2000, 24:115–134.CrossRefPubMedGoogle Scholar
  46. (46).
    Stroebe M, Stroebe W, Schut H, Zech E, van den Bout J: Does disclosure of emotions facilitate recovery from bereavement? Evidence from two prospective studies. Journal of Consulting and Clinical Psychology. 2002, 70:169–178.CrossRefPubMedGoogle Scholar
  47. (47).
    Spiegel D, Classen C: Group Therapy for Cancer Patients: A Research-Based Handbook of Psychosocial Care. New York: Basic Books, 2000.Google Scholar
  48. (48).
    Antoni MH, Lehman JM, Kilbourn KM, et al.: Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early stage breast cancer. Health Psychology. 2001, 20:20–32.CrossRefPubMedGoogle Scholar
  49. (49).
    Friedman EM, Irwin MR: Modulation of immune cell function by the autonomic nervous system. Pharmacology and Therapeutics. 1997, 74:27–38.CrossRefPubMedGoogle Scholar
  50. (50).
    McEwen BS, Biron CA, Brunson KW, et al.: The role of adrenocorticoids as modulators of immune function in health and disease: Neural, endocrine, and immune interactions. Brain Research Reviews. 1997, 23:79–133.CrossRefPubMedGoogle Scholar
  51. (51).
    Epel ES, McEwen BS, Ickovics JR: Embodying psychological thriving: Physical thriving in response to stress. Journal of Social Issues. 1998, 54:301–322.CrossRefGoogle Scholar
  52. (52).
    Seligman MEP, Csikszentmihalyi M: Positive psychology [Special issue]. American Psychologist. 2000, 55(1).Google Scholar
  53. (53).
    Ryan RM, Sheldon KM, Kasser T, Deci EL: All goals are not created equal: An organismic perspective on the nature of goals and their regulation}. In Gollwitzer PM, Bargh JA (eds), The Psychology of Action: Linking Cognition and Motivation to Behavior. New York: Guilford, 1996, 7–26.Google Scholar
  54. (54).
    Schmale AH: Giving up as a final common pathway to changes in health. Advances in Psychosomatic Medicine. 1972, 8:20–40.CrossRefPubMedGoogle Scholar
  55. (55).
    Fleshner M, Laudenslager ML, Simons L, Maier SL: Reduced serum antibodies associated with social defeat in rats. Physiology and Behavior. 1989, 45:1183–1187.CrossRefPubMedGoogle Scholar
  56. (56).
    Stefanski V, Ben-Eliyahu S: Social confrontation and tumor metastasis in rats: Defeat and beta-adrenergic mechanisms. Physiology and Behavior. 1996, 60:277–282.CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2003

Authors and Affiliations

  • Julienne E. Bower
    • 1
    Email author
  • Margaret E. Kemeny
    • 2
  • Shelley E. Taylor
    • 3
  • John L. Fahey
    • 4
  1. 1.Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesUSA
  2. 2.Health Psychology ProgramUniversity of CaliforniaSan FranciscoUSA
  3. 3.Department of PsychologyUniversity of CaliforniaLos AngelesUSA
  4. 4.Departments of Microbiology and Immunology, Immunology, and Molecular GeneticsUniversity of CaliforniaLos AngelesUSA

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