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organs or tissues, such as the skin, where they are more likely to encounter antigens (Dhabhar & McEwen, 1997). This illustrates the complexity of understanding the pattern of changes in immune function, particularly when only one or two measures of immune function are assessed. Thus, the term immune dysregulation is probably a more descriptive term than immune suppression (or enhancement) when discussing general changes in immune function. Although the HPA axis signi cantly modulates immune function, other pathways also exist, as noted when the blastogenic response to phytohemagglutinin (PHA) was still suppressed following stress, despite removal of the adrenal glands (Keller, Weiss, Schleifer, Miller, & Stein, 1983). Later studies suggested that the sympathetic nervous system is another important modulator of immune function (Felten, Felten, Carlson, Olschowka, & Livnat, 1985; Irwin, 1993). Sympathetic Nervous System (SNS) As with the HPA axis, the hypothalamus is centrally involved in the regulation of autonomic nervous system activity. Neurons in the hypothalamus project to autonomic centers in the lower brainstem and spinal cord, including preganglionic sympathetic neurons (Luiten, ter Horst, Karst, & Steffens, 1985). During a classical ght or ight response,



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This procedure has a problem, however. If the user clicks the Cancel button in the input box, the procedure deletes any data already in the cell. The following modification checks for the Cancel button clicks and takes no action:





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Stroke, 19, 1101 1107 1992 HCFA Statistics (1992) US Department of Health and Human Services, Health Care Financing Administration, Bureau of Data Management and Strategy HCFA Pub No 03333 (pp 212 216) Oldenberg, B, Perkins, R, & Andrews, G (1985) Controlled trial of psychological intervention in myocardial infarction Journal of Consulting and Clinical Psychology, 53, 852 859 O Leary, A (1992) Self-efficacy and health: Behavioral and stress-physiological mediation Cognitive Therapy and Research, 16, 229 245 Ornish, D, Scherwitz, L W, Billings, J H, Gould, L, Merritt, T A, & Sparler, S (1998) Intensive lifestyle changes for reversal of coronary heart disease Journal of the American Medical Association, 280, 2001 2007 Oxman, T, Freeman, D, & Manheimer, E (1995) Lack of social participation or religious strength and comfort as risk factors for death after cardiac surgery in the elderly.

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Psychosomatic Medicine, 57, 5 15 Pallak, M S, Cummings, N A, Dorken, H, & Henke, C J (1994) Medical costs, Medicaid, and managed mental health treatment: The Hawaii study Management Care Questionnaire, 2, 64 70 Pennebaker, J W, Kiecolt-Glaser, J K, & Glaser, R (1988) Disclosure of traumas and immune function: Health implications for psychotherapy Journal of Consulting and Clinical Psychology, 56, 239 245 Pereira, D, Antoni, M H, Simon, T, Efantis-Potter, J, Carver, C S, Duran, R, et al (2003) Stress and squamous intraepithelial lesions in women with human papillomavirus and human immunodeficiency virus Psychosomatic Medicine, 65, 427 434 Peterson, C, Seligman, M E P, & Vaillant, G E (1988) Pessimistic explanatory style is a risk factor for physical illness: A thirty-five year longitudinal study Journal of Personality and Social Psychology, 55, 23 27 Pettingale, K.

information Research has also given evidence that an ego orientation is related to other unacceptable achievement strategies, such as the use of aggression (Rascle, Coulomb, & Pfister, 1998) These studies demonstrate that the achievement strategies endorsed by physical activity participants are meaningfully related to their goal perspective Across studies, task orientation was coupled with adaptive learning strategies, the value of practice to learn new skills and improve, and seeking task-relevant information In contrast, ego-oriented athletes endorsed avoiding practice as an achievement strategy and avoided task-relevant information, preferring normative feedback ( but only when high in perceived ability) Exerted Effort and Performance There is little research to date investigating exerted effort and performance One of the first studies to provide evidence of a performance boost from being task-involved was Vealey and Campbell s (1989).

, Greer, S, & Tee, D (1977) Serum IgA and emotional expression in breast cancer patients Journal of Psychosomatic Research, 21, 395 399 Regier, D (1994) Health care reform: Opportunities and challenge In S Blumenthal, K Matthews, & S Weiss (Eds), New research frontiers in behavioral medicine (Proceedings of the National Conference; NIH Publication No 94-3772, pp 19 24) Washington, DC: US Government Printing Office Richter, J, Obrecht, W, Bradley, L, Young, L, & Anderson, K (1986) Psychological comparison of patients with nutcracker esophagus and irritable bowel syndrome Digestive Disorder Science, 31, 131 138 Richter, S, Brown, S, & Mott, M (1991) The impact of social support and self-esteem on adolescent substance abuse treatment outcome Journal of Substance Abuse, 3(4), 371 385 Robertson, E K, & Suinn, R M (1968).

The determination of rate of progress of stroke patients through empathy measures of patient and family Journal of Psychosomatic Research, 12, 189 191..

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