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Stress Management or Post-traumatic Growth Facilitation to Diminish Distress in Cancer Survivors? A Randomized Controlled Trial
Abstract
This randomized controlled trial compared the efficacy of cognitive behavioral stress management (CBSM) and positive psychotherapy in cancer (PPC) to reduce post-traumatic stress symptoms (PTSS) and distress, and to promote post-traumatic growth (PTG) in cancer survivors. Participants were 140 adult women randomly allocated to CBSM (n = 73) or PPC (n = 67). PTSS, distress, and PTG were assessed at pre-and post-intervention, and at 3-and 12-month follow-ups. Analysis showed PPC was more effective in decreasing PTSS (b = −7.61, p <.001) and distress (b = −3.66; p <.001) than CBSM, but neither therapy significantly increased PTG (b = 0.77, p = .76). The relational veracity of PTG and its role predicting reduced PTSS was observed only in the PPC arm. In conclusion, PPC appears to be a valid therapeutic option for assimilating and accommodating the experience of cancer after treatment completion.
... The characteristics of the 16 studies included are illustrated in Table 2 (Appendix A). The studies were published between 2007 and 2021 and most of them were conducted in the USA, 12,[28][29][30][31][32][33][34][35] whilst the remaining studies were conducted in Spain, [36][37][38] UK, 39 Hong Kong, 40 Sweden, 41 and Australia. 42 All articles were written in English and published in peer-reviewed journal. ...
... 42 All articles were written in English and published in peer-reviewed journal. RCTs were the most common study design 28,29,[33][34][35]37,38,41,42 followed by pilot studies and case series 12,[30][31][32]40 an open trial, 39 and non-randomized trial. 36 The sample size of the studies varied greatly ranging from five to 347 and all studies were conducted on middle-aged populations and -1067 mostly on women. ...
... CBT-based [28][29][30][31][32]34,35,39,40,42 and non-CBT based 12,33,[36][37][38]41 ...
Objective:
We reviewed the evidence regarding the effectiveness of therapist-led interventions for reducing symptoms of traumatic stress in cancer survivors METHODS: This systematic review was completed in accordance with the guidelines illustrated by Popay and colleagues and the following online databases, PsychInfo, Medline, CINAHL, were searched for peer-reviewed literature. Further studies were searched through Google Scholar and manually scanning the reference lists of all included studies. The PRISMA guidelines were followed to report results.
Results:
Sixteen studies were identified, their quality varied and the interventions broadly fell into two categories: CBT-based and non-CBT interventions. Effect sizes were small to moderate in twelve studies and large in four. Drop-out rates were mostly low.
Conclusion:
This review has demonstrated that the research in this field is still scarce and due to the data mostly suggesting a small to moderate effect, firm conclusions cannot be drawn on the effectiveness of the included interventions. This article is protected by copyright. All rights reserved.
... The first clinical trial of face-to-face PPC groups vs. treatment as usual and waiting lists showed promising preliminary results for its efficacy to reduce distress (15). Similarly, a recent randomized controlled trial (RCT) (16), which compared PPC groups with cognitivebehavioral stress management groups(10), also demonstrated better PPC results. ...
... This pre-registered study (NCT03010371) included two consecutive clinical trials to compare 1) face-to-face PPC vs. stress-management (16), and 2) face-to-face PPC vs. online PPC. The present paper covers the second trial, in which a two-arm, pragmatic RCT was conducted within the routine practice of public health centers. ...
Objective
This study assesses the effectiveness of face‐to‐face group positive psychotherapy for cancer survivors (PPC) compared to its online adaptation, online group positive psychotherapy for cancer survivors (OPPC), which is held via videoconference. A two‐arm, pragmatic RCT was conducted to examine the effects of both interventions on emotional distress, posttraumatic stress (PTSS) and posttraumatic growth (PTG) among cancer survivors and analyze attrition to treatment.
Methods
Adult women with a range of cancer diagnoses were invited to participate if they experienced emotional distress at the end of their primary oncological treatment. Emotional distress, PTSS and PTG were assessed at baseline, immediately after treatment and three months after treatment. Intention‐to‐treat analyses were carried out using general linear mixed models to test the effect of the interventions overtime. Logistic regressions were performed to test differential adherence to treatment and retention to follow‐up.
Results
A total of 269 individuals participated. The observed treatment effect was significant in both modalities, PPC and OPPC. Emotional distress (b = − 2.24, 95%CI = ‐3.15‐ −1.33) and PTSS (b = − 3.25, 95%CI = ‐4.97‐ −1.53) decreased significantly over time, and PTG (b = 3.08, 95%CI = 0.38‐5.78) increased significantly. Treatment gains were sustained across outcomes and over time. Analyses revealed no significant differences between modalities of treatment, after adjusting for baseline differences, finding that OPPC is as effective and engaging as PPC.
Conclusions
The OPPC treatment was found to be effective and engaging for female cancer early survivors. These results open the door for psycho‐oncology interventions via videoconference, which are likely to lead to greater accessibility and availability of psychotherapy.
This article is protected by copyright. All rights reserved.
... An examination of the extant literature revealed that a wide variety of events, such as life-threatening physical illness (Hefferon et al., 2009), severe physical injury (Kampman et al., 2015), natural disaster (Nalipay et al., 2017), bereavement (Michael & Cooper, 2013), cancer (Ochoa-Arnedo et al., 2020), childbirth (Delicate et al., 2018), interpersonal violence (Elderton et al., 2017), terrorist attacks (Park et al., 2012), coup attempt (Simsir & Dilmac, 2018b), and vicarious trauma (Cohen & Collens, 2013) may lead to PTG in a significant number of people. ...
Although forced displacement may lead to many adverse psychological problems, this experience may also result in positive psychological consequences. Given the increasing
disturbance in countries, many people are forcibly displaced, a comprehensive understanding of the posttraumatic growth (PTG) experiences of refugees is warranted.
In this study, we examined 12 primary studies exploring PTG among refugees using the qualitative metasynthesis method. Our analysis of the primary studies consisting of
319 adults revealed four themes: (a) improved psychologic functioning; (b) enhanced interpersonal relationships; (c) reconstruction of the meaning of life; and (d) positive future direction. These findings indicate that no matter how traumatic experiences are painful, people can hold on to life, build a new life, and grow from adversity.
... Step 4: intensive online group psychotherapy If the patient does not improve within 2 weeks during step 3, she will be offered the option to participate in weekly group-based psychotherapy (App ICOnnecta't Videoconsulta), which is based on the Group Positive Psychotherapy programme for cancer survivors 26 27 and adapted for patients under primary oncological treatments. Group positive psychotherapy has been compared with a waiting-list control group in a previous study 28 and to other evidence-based interventions 29 and showed better results in terms of patients' psychological well-being. This step will compromise 8 weekly 90 min sessions led by a clinical psychologist (an expert in psycho-oncology) with a follow-up 3 months later. ...
Introduction Psychosocial interventions for patients with breast cancer (BC) have demonstrated their effectiveness at reducing emotional distress and improving quality of life. The current digitisation of screening, monitoring and psychosocial treatment presents the opportunity for a revolution that could improve the quality of care and reduce its economic burden. The objectives of this study are, first, to assess the effectiveness of an e-health platform with integrated and stepped psychosocial services compared with usual psychosocial care, and second, to examine its cost–utility.
Methods and analysis This study is a multicentre randomised controlled trial with two parallel groups: E-health intervention with integrated and stepped psychosocial services vs usual psychosocial care. An estimated sample of 338 patients with BC in the acute survival phase will be recruited from three university hospitals in Catalonia (Spain) and will be randomly assigned to one of two groups. All participants will be evaluated at the beginning of the study (T1: recruitment), 3 months from T1 (T2), 6 months from T1 (T3) and 12 months from T1 (T4). Primary outcome measures will include number of clinical cases detected, waiting time from detection to psychosocial intervention and proportion of cases successfully treated in the different steps of the intervention, as well as outcomes related to emotional distress, quality of life, post-traumatic stress and growth, treatment adherence and therapeutic alliance. Secondary outcomes will include the acceptability of the platform, patients’ satisfaction and usability. For the cost–utility analysis, we will assess quality-adjusted life years and costs related to healthcare utilisation, medication use and adherence, work absenteeism and infrastructure-related and transport-related costs.
Ethics and dissemination This study was approved by the Ethics committee of the Institut Català d’Oncologia network in Hospitalet, Spain. Findings will be disseminated through peer-reviewed journals, reports to the funding body, conferences among the scientific community, workshops with patients and media press releases.
Trial registration number Online Psychosocial Cancer Screening, Monitoring and Stepped Treatment in Cancer Survivors (ICOnnectat-B),NCT04372459.
... En su formato presencial, este tratamiento grupal ha demostrado ser más efectivo en la reducción del malestar emocional y el estrés postraumático y en la mejora de la calidad de vida que una terapia grupal cognitivo conductual de manejo del estrés (43) o un grupo de lista de espera (44 ). Por último, un reciente ensayo clínico controlado y aleatorizado ha demostrado que el formato online presenta el mismo nivel de eficacia que el formato presencial (37) . ...
Introducción: A pesar de que los tratamientos psico-oncológicos han demostrado su efectividad en disminuir el malestar emocional y mejorar la calidad de vida de las personas con cáncer, aún existen numerosas barreras que limitan su acceso. La transformación a online de esta atención se plantea como una solución para aumentar la cobertura del servicio y mejorar su coste-utilidad. Objetivo: Crear un ecosistema digital de salud para reducir el impacto del cáncer, aumentando el bienestar y la calidad de vida del ciudadano con cáncer. Método: Programa dirigido a pacientes diagnosticadas de cáncer de mama en fase de supervivencia aguda. Es un programa de atención escalonada dividido en 4 niveles de intervención jerarquizados por complejidad: Nivel 1, cribado y monitorización psicosocial; Nivel 2, Campus: psicoeducación y educación sanitaria; Nivel 3, soporte psicosocial comunitario; y Nivel 4, tratamiento psicoterapéutico grupal. Resultados: En 2019, 259 mujeres fueron incluidas en el programa (39,91% de los nuevos casos de cáncer de mama en los centros participantes). Solo el 3,47% (n = 9) requirió atención clínica especializada (Nivel 4). Conclusión: El programa Iconnecta’t adopta un modelo integrado de atención psicosocial en cáncer que se adecúa a las necesidades específicas de los supervivientes. Da solución a algunas de las barreras de la atención sanitaria tradicional, democratizando el acceso a los servicios mediante el uso de tecnologías de uso común en la mayoría de ciudadanos. En un futuro próximo se prevé la implementación progresiva a otras neoplasias, junto con un ensayo clínico controlado y aleatorizado que evaluará su eficacia.
Breast cancer is associated with adverse physical and psychological consequences. Although research has identified the various benefits linked to psychosocial interventions, mixed results have been found in relation to peer support. The aim of the present systematic review and meta-ethnography is to explore the qualitative evidence on the experience of breast cancer survivors in peer support. A systematic search of the literature was conducted until June 2023, and a meta-ethnographic approach was used to synthesize the included papers. Eleven articles were included, collecting the experience of 345 participants. The following four core areas involved in peer support implementation were identified from the synthesis: Peer support can create understanding and a mutual therapeutic and emotional connection; peer support can facilitate an educational and supportive patient-centered journey ; peer support should monitor group members for unpleasant emotional experiences; peer support should have professional supervision of recruitment and Derek Clougher and Laura Ciria-Suarez contributed equally to this work.
The detrimental effects of Post-Traumatic Stress Symptoms (PTSS) and Post-Traumatic Stress Disorder (PTSD) and the benefits of Post-Traumatic Growth (PTG) are well established for cancer survivors. Increased cancer survival rates necessitate an understanding of how these two paradoxical outcomes, PTSS/PTSD and PTG, are targeted through interventions. This systematic scoping review aims to (a) examine existing evidence on interventions targeting PTSS/PTSD and/or PTG among cancer survivors and (b) identify knowledge gaps to inform future research. Following the six steps of a scoping review, 76 articles met the inclusion criteria. Quantitative articles were examined using descriptive analysis. Frequency counts of the collated data were tabulated into summary tables. Qualitative articles were reviewed using meta-synthesis. Most articles were quantitative (n = 52) and targeted PTG (n = 68) through promising intervention approaches such as psychotherapy, mindfulness, physical activity, and psilocybin-assisted therapy. Three key implications for future research and practice were synthesized: (1) mechanistic considerations for intervention design that provide a roadmap for rigorous and theoretically-grounded research; (2) the need for improved representation of cancer survivors in trials; and (3) potential facilitators of intervention efficacy. Together, these findings can direct future research to optimize interventions to reduce PTSS/PTSD and promote PTG achievement among cancer survivors.
Background/Objective
Environmental factors such as psychosocial stress have demonstrated to have an impact on the breast cancer (BC) course. This study aims to explore the impact of psychotherapy and stressful life events (SLE) on BC survivors’ illness trajectories.
Method
68 women with BC underwent Positive Psychotherapy or Cognitive-Behavioral Stress Management and 37 patients were included as a control group. The effects of distress reduction and SLE on their 5-year recurrence were investigated. Additional analyses examined the effect of receiving vs. not receiving psychotherapy and of the type of therapy on survival and disease-free interval, DFI.
Results
A one-point decrease of the Hospital Anxiety and Depression Scale (HADS) after psychotherapy predicted a lower risk of 5-year recurrence, OR = 0.84, p = .037, 95% CI = 0.71-0.99). Also, a one point-increase in the number threatening SLE (OR = 1.92; p = .028, 95% CI = 1.07-3.43) was related to higher 5-year recurrence.
Conclusions
The findings highlight the necessity of studying not only a given situation (i.e., psychotherapy, SLE) but its specific impact on individuals.
Adolescents who experience cybervictimization are at increased risk for suicidal ideation. However, not all adolescents who suffer cybervictimization experience suicidal ideation, suggesting the importance of investigating protective factors that might potentially buffer and decrease these thoughts of death. The present study focused on examining the buffering effects of core self-evaluation (CSE) in the relationship between cybervictimization and suicidal ideation among Spanish adolescents. A moderated model was tested in two studies with two independent samples and designs. In Study 1 (cross-sectional design), a total of 858 students (53% female and 46.4% male; Mage = 15.75, SD = 1.27) completed the measures. In Study 2 (four-month prospective design), the sample consisted of 835 students (54.1% female and 45.9% male, Mage = 13.71, SD = 1.31). Main results showed that CSE might play a differential moderating role in the relationship between cybervictimization and suicidal ideation in both studies. Our findings suggest that adolescents who reported cybervictimization and lower rates of CSE tended to show higher levels of suicidal ideation. A focus on adolescents' evaluations of themselves and their worthiness and competence (i.e., on CSE) may contribute to intervention efforts targeting to prevent suicide after cybervictimization. The implications of these findings for adolescents, educators, and school counselling practitioners are considered.
The effectiveness of positive psychology interventions in the treatment of stress-related difficulties have not been well established. To estimate the effectiveness of positive psychology interventions on the reduction of stress-related symptoms, a systematic review using PubMed, Scopus, Wiley, Psychinfo, Cochrane and Sage databases with no limitation of date of publication was conducted. We identified additional studies by searching positive psychology reviews and academic books. Only studies trying positive interventions that included measures of anxiety, stress, or PTSD symptoms were reviewed. We extracted data using predefined data fields and study quality was assessed with the NIH study quality assessment tools. Twenty-nine records were included in this study: twenty-three controlled trials and six pre-post studies. Every study showed significant improvement in at least one dimension. Several studies reported improvements in well-being as well. This review shows promising results of positive psychology interventions as a treatment for stress-related difficulties. However, important methodological biases and strong heterogeneity among the studies highlight the need for replication and better validation of positive psychology interventions.
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Post-traumatic stress and growth are common responses to adverse life events such as cancer. In this article, we establish how cancer becomes a "fertile land" for the emergence of stress and growth responses and analyze the main mechanisms involved. Stress-growth responses on adjusting to cancer is potentially determined by factors like the phase of the illness (e.g., initial phases vs. period of survivorship), patient's coping strategies, meaning-making, and relationships with significant others. We also review the mechanisms of constructive and adaptative stress-growth balances in cancer to study the predictors, interrelated associations, triggering mechanisms, long-term results, and specific trajectories of these two responses to cancer. Finally, we update the evidence on the role of these stress-growth associations in psychologically adjusting to cancer. Together with this evidence, we summarize preliminary results regarding the efficacy of psychotherapeutic interventions that aim to facilitate a constructive psychological balance between stress and growth in cancer patients. Recommendations for future research and gaps in knowledge on stress-growth processes in this illness are also highlighted. Researchers are encouraged to design and use psychotherapeutic interventions according to the dynamic and changeable patients' sources of stress and growth along the illness. Relevant insights are proposed to understand the inconsistency of stress-growth literature and to promote psychotherapeutic interventions to facilitate a constructive balance between these key responses in cancer.
Background
Although positive psychology interventions (PPIs) show beneficial effects on mental health in non-clinical populations, the current literature is inconclusive regarding its effectiveness in clinical settings. We aimed to examine the effects of PPIs on well-being (primary outcome), depression, anxiety, and stress (secondary outcomes) in clinical samples with psychiatric or somatic disorders.
Methods
A systematic review and meta-analysis was conducted following PRISMA guidelines. PsycINFO, PubMed, and Scopus were searched for controlled studies of PPIs in clinical samples between Jan 1, 1998 and May 31, 2017. Methodological quality of each study was rated. We used Hedges’ adjusted g to calculate effect sizes and pooled results using random-effect models.
Results
Thirty studies were included, representing 1864 patients with clinical disorders. At post-intervention, PPIs showed significant, small effect sizes for well-being (Hedges’ g = 0.24) and depression (g = 0.23) compared to control conditions when omitting outliers. Significant moderate improvements were observed for anxiety (g = 0.36). Effect sizes for stress were not significant. Follow-up effects (8–12 weeks), when available, yielded similar effect sizes. Quality of the studies was low to moderate.
Conclusion
These findings indicate that PPIs, wherein the focus is on eliciting positive feelings, cognitions or behaviors, not only have the potential to improve well-being, but can also reduce distress in populations with clinical disorders. Given the growing interest for PPIs in clinical settings, more high quality research is warranted as to determine the effectiveness of PPIs in clinical samples.
Trial registration PROSPERO CRD42016037451
The current study investigated the effects of a brief psycho-educational presentation about posttraumatic growth (PTG: positive changes that may occur as a result of psychological struggle with a highly stressful life event) on the self-reported PTG by using the PTG Inventory (PTGI). Few empirical studies have investigated the possible ceiling or floor effects of the PTGI, despite researchers indicating the necessity of longitudinal studies to reveal the PTG processes. This study used a pre-test, brief presentation, and post-test longitudinal design to examine the effects of intervention among adolescents by considering the floor and ceiling effects of the PTGI. Participants, 54 high school students (37 females, 17 males, Mean age = 15.92 years), completed the PTGI at three weeks interval. Results using the Latent Rank Theory approach demonstrated ceiling effects in students who reported a high degree of PTG at Time 1, and floor effects in students with low PTG at Time 1. Presentation effects were not evident even in those who reported a moderate degree of PTG at Time 1. These findings suggest that it is important to be aware of the ceiling/floor effects while measuring changes in PTG perception over time and that explaining the phenomenon of PTG is not likely to be enough to affect the PTG perceptions.
Background/Objective
There is increasing evidence that positive life changes, such as posttraumatic growth (PTG), can result from the experience of coping with cancer. However, no interventions have been specifically designed to facilitate the development of PTG in cancer. In this article, we describe and assess the results of Positive Psychotherapy for Cancer (PPC) survivors. It aims to facilitate PTG as a way of achieving significant reductions in the symptoms of emotional distress and posttraumatic stress. In addition, the corroboration of this PTG facilitation is assessed using interpersonal indicators. Method: We allocated 126 consecutive survivors of cancer with high levels of emotional distress and who were seeking psychological support to either an experimental group (PPC) or a waiting list group. Results: The PPC group obtained significantly better results after treatment than the control group, showing reduced distress, decreased posttraumatic symptoms, and increased PTG. The benefits were maintained at 3 and 12 months’ follow-up. Participants’ PTG was correlated to the PTG that their significant others attributed to them, corroborating PTG facilitation. Conclusions: PPC appears to promote significant long-term PTG and can reduce emotional distress and posttraumatic stress in cancer survivors. In addition, PTG facilitation induced by PPC is corroborated by significant others.
Traditionally, treatments for depression have been primarily focused on reducing patients’ symptoms or deficits and less concerned with building positive resources. This study aims to compare the efficacy of a manualized protocol of empirically-validated positive psychology interventions (PPI) with a cognitive-behavioral therapy (CBT) protocol. This controlled clinical trial included 96 adult women with a DSM-IV diagnosis of major depression or dysthymia. Participants were blindly allocated to a 10-session PPI (n = 47) or CBT (n = 49) group therapy condition. Intention to treat analysis showed that both interventions were effective in reducing clinical symptoms and increasing well-being. There were no significant differences between groups in either main outcomes (i.e., severity of depressive symptoms and clinical diagnosis) or secondary outcomes (e.g., positive and negative affect, and satisfaction with life). Even within the most severely depressed participants, no differences between PPI and CBT emerged. If further clinical studies confirm these results, this would widen treatment choice for both patients and professionals.
Being diagnosed with cancer and undergoing subsequent treatment can produce high levels of distress among patients. Several psychotherapeutic approaches have sought to help cancer patients manage these negative impacts. In addition, however, there is now increasing evidence regarding the collateral positive outcomes of the cancer experience, it being concluded that positive life changes may also result from such adversity. Consequently, therapies focusing on the emergence of these positive changes have also been developed. In this chapter, we describe a positive psychotherapy for cancer survivors, one which aims to facilitate posttraumatic growth as a way of achieving a significant reduction in negative emotional states (emotional distress or posttraumatic symptoms). A further goal of this positive psychology approach in cancer is to work with positive emotions and positive functioning so as to promote healthy lifestyles, a return to work, and social supportive behaviors.
Growth models (also known as linear mixed effects models, multilevel models, and random coefficients models) have the capability of studying change at the group as well as the individual level. In addition, these methods have documented advantages over traditional data analytic approaches in the analysis of repeated-measures data. These advantages include, but are not limited to, the ability to incorporate time-varying predictors, handle dependence among repeated observations in a very flexible manner, and to provide accurate estimates with missing data under fairly unrestrictive missing data assumptions. The flexibility of the growth curve modeling approach to the analysis of change makes it the preferred choice in the evaluation of direct, indirect and moderated intervention effects. Although offering many benefits, growth models present challenges in terms of design, analysis and reporting of results. This paper provides a nontechnical overview of growth models in the analysis of change in randomized experiments and advocates for their use in the field of internet interventions. Practical ecommendations for design, analysis and reporting of results from growth models are provided.
Objective: Systematic reviews highlight a broad range of CR-PTSD prevalence estimates in cancer survivors. This meta-analysis was conducted to provide a prevalence estimate of significant CR-PTSD symptoms and full diagnoses to facilitate the psychological aftercare of cancer survivors.
Methods: A systematic literature search was conducted for studies using samples of cancer survivors using validated clinical interviews and questionnaires to assess the prevalence of CR-PTSD (k=25, n=4189). Prevalence estimates were calculated for each assessment method using random-effects meta-analysis. Mixed-effects meta-regression and categorical analyses were used to investigate study-level moderator effects.
Results: Studies using the Posttraumatic Stress Disorder Checklist – Civilian Version (PCL-C) yielded lower event rates using cut-off (7.3%, 95% CI=4.5-11.7, k=10) than symptom cluster (11.2%, 95% CI=8.7-14.4, k=9). Studies using the Structured Clinical Interview (SCID) yielded low rates for lifetime (15.3%, 95% CI=9.1-25, k=5) and current CR-PTSD (5.1%, 95% CI=2.8-8.9, k=9). Between-study heterogeneity was substantial (I2=54-87%). Studies with advanced-staged samples yielded significantly higher rates with PCL-C cluster scoring (p=.05), and when assessing current CR- PTSD on the SCID (p=.05). The effect of mean age on current PTSD prevalence met significance on the SCID (p=.05). SCID lifetime prevalence rates decreased with time post-treatment (R2= .56, p<.05).
Discussion: The cancer experience is sufficiently traumatic to induce PTSD in a minority of cancer survivors. Post-hoc analyses suggest that those who are younger, are diagnosed with more advanced disease, and recently completed treatment, may be at greater risk of PTSD. More research is needed to investigate vulnerability factors for PTSD in cancer survivors.
Objective:
Survivors of breast cancer experience stress and are at risk for depressive symptoms following primary treatment. Group-based interventions such as cognitive-behavioral stress management (CBSM) delivered postsurgery for nonmetastatic breast cancer (BCa) were previously associated with fewer depressive symptoms over a 12-month follow-up; few studies have examined the longer-term benefits of such psychosocial interventions. This 5-year follow-up study of a previously conducted trial (#NCT01422551) tested whether group-based CBSM following surgery for nonmetastatic BCa was associated with fewer depressive symptoms.
Methods:
Women (N = 240) with Stage 0-IIIb BCa were recruited 2-10 weeks postsurgery and randomized to a 10-week CBSM intervention group or a 1-day psycho-educational control group. Women were recontacted 5 years poststudy enrollment and reconsented to participate in the follow-up study (N = 130). Depressive symptomatology was assessed using the Center for Epidemiologic Studies-Depression scale (CES-D). ANOVA and ANCOVA analyses were employed to test for group differences on the CES-D at 5-year follow-up accounting for relevant covariates.
Results:
Participants assigned to CBSM reported significantly fewer depressive symptoms (M = 9.99, SE = 0.93) at the follow-up compared with those in the control group (M = 12.97, SE = 0.99), p = .030. With covariates, the group difference remained significant, p = .012.
Conclusion:
Women who received CBSM postsurgery for BCa reported fewer depressive symptoms than those in the control group in this 5-year follow-up. Psychosocial interventions early in treatment may influence long-term psychological well-being in BCa survivors.
Objetivo: Las enfermedades graves como el cáncer pueden vivirse como experiencias traumáticas y/o como impulso para realizar cambios vitales positivos (ej. crecimiento pos- traumático). El programa de psicoterapia posi- tiva grupal para supervivientes de cáncer que realizamos integra ambos elementos, trauma y crecimiento. Los objetivos del programa no son sólo la reducción de emociones negativas (malestar emocional o sintomatología postrau- mática) sino el trabajo con emociones positivas y la facilitación de crecimiento postraumáti- co.
Método: Los elementos de trabajo psico- terapéutico que han mostrado evidencia en la consecución de estos objetivos y que compo- nen los módulos de este programa son: favore- cer la expresión y procesamiento emocional, entrenar habilidades de regulación emocional y estrategias de afrontamiento, trabajo con elementos facilitadores del crecimiento pos- traumático y confrontación con los aspectos existenciales y espirituales que surgen tras el diagnóstico y tratamiento oncológico. Además de estos aspectos psicoterapéuticos, comple- mentamos el programa con otros factores re- levantes en la adaptación psicosocial tras la enfermedad como: el fomento de estilos de vida saludables, la adherencia a los tratamien- tos oncológicos, la reinserción laboral y los comportamientos solidarios.
Background
The use of positive psychological interventions may be considered as a complementary strategy in mental health promotion and treatment. The present article constitutes a meta-analytical study of the effectiveness of positive psychology interventions for the general public and for individuals with specific psychosocial problems.
Methods
We conducted a systematic literature search using PubMed, PsychInfo, the Cochrane register, and manual searches. Forty articles, describing 39 studies, totaling 6,139 participants, met the criteria for inclusion. The outcome measures used were subjective well-being, psychological well-being and depression. Positive psychology interventions included self-help interventions, group training and individual therapy.
Results
The standardized mean difference was 0.34 for subjective well-being, 0.20 for psychological well-being and 0.23 for depression indicating small effects for positive psychology interventions. At follow-up from three to six months, effect sizes are small, but still significant for subjective well-being and psychological well-being, indicating that effects are fairly sustainable. Heterogeneity was rather high, due to the wide diversity of the studies included. Several variables moderated the impact on depression: Interventions were more effective if they were of longer duration, if recruitment was conducted via referral or hospital, if interventions were delivered to people with certain psychosocial problems and on an individual basis, and if the study design was of low quality. Moreover, indications for publication bias were found, and the quality of the studies varied considerably.
Conclusions
The results of this meta-analysis show that positive psychology interventions can be effective in the enhancement of subjective well-being and psychological well-being, as well as in helping to reduce depressive symptoms. Additional high-quality peer-reviewed studies in diverse (clinical) populations are needed to strengthen the evidence-base for positive psychology interventions.
Various proposals have been made in order to measure worldviews and identity in extreme trauma or loss experiences. The use of these scales has provided mixed results. The Vital Impact Assessment Scale (VIVO) was designed to fill some of the gaps of the existing tools: (a) to be administered to the general population, as well as to survivors of extreme experiences; (b) to include an extensive range of human responses to extreme situations; (c) to be administered to large population samples from different cultural backgrounds; (d) to avoid anchoring to a specific personal experience; and (e) to work with extensive and complex response profiles. Validation data and preliminary results are presented for the Spanish version, and an English formulation is proposed. The final version of the VIVO Questionnaire, composed of 116 items, offers an organized profile divided into 10 conceptual blocks (worldviews, attitude towards the world, view of human beings, coping, impact of past situations, emotions, telling the experience, consequences, social support, and identity) and 35 subscales.
There are few interventions for couples facing cancer.
This study aims to investigate the utility of providing dyadic skills to these couples.
Woman recently diagnosed with breast or gynecological cancer and their partners were randomly assigned to either a couple-skills intervention (Side by Side) or to cancer education (Couples Control Program). Assessments with self-report and behavioral observation of both partners were conducted four times over 16 months.
Multilevel analyses of data from 72 participating couples suggest that females receiving Side by Side showed larger reductions in fear of progression, and couples reported less avoidance in dealing with the cancer, more posttraumatic growth, and better relationship skills relative to the Couples Control Program. All differences favoring Side by Side disappeared by 16 months after the diagnosis.
Short-term changes in functioning may be improved by enhancing couples' dyadic skills during acute medical treatment of the disease.
There is increasing research on posttraumatic growth after life-threatening illnesses such as cancer and HIV/AIDS, although it is unclear whether growth confers any psychological or physical benefits in such samples. Consequently, this meta-analysis explored the relationship between posttraumatic growth and psychological and physical wellbeing in adults diagnosed with cancer or HIV/AIDS and examined potential moderators of these relationships. Analysis of 38 studies (N=7927) of posttraumatic growth after cancer or HIV/AIDS revealed that growth was related to increased positive mental health, reduced negative mental health and better subjective physical health. Moderators of these relationships included time since the event, age, ethnicity, and type of negative mental health outcome. It is hoped that this synthesis will encourage further examination of the potentially complex relationship between posttraumatic growth and adjustment in individuals living with life-threatening medical conditions.
The PTSD Checklist-Civilian version (PCL-C) was used as a screening tool to assess the presence of PTSD symptoms. The aim of this study was to explore the factorial structure of the Spanish version of the PCL-C and calculate the correlation of PTSD symptoms with distress and health-related quality of life.
The sample included 494 cancer outpatients. In order to validate the PCL-C, a principal component analysis was applied. The association between variable was measured by Pearson correlation.
Findings evidenced three symptoms clusters on the PCL-C version, defined as Hyperarousal/Re-experiencing, Numbing and Avoidance. About 10% of the total sample met clinical PTSD symptoms. In addition, PTSD symptoms were related negatively to health-related quality of life and positively related with distress.
The conceptualization of PTSD symptoms for cancer patients is supported by the specific symptom clusters identified on PCL-C.
The authors tested effects of a 10-week group cognitive-behavioral stress management intervention among 100 women newly treated for Stage 0-II breast cancer. The intervention reduced prevalence of moderate depression (which remained relatively stable in the control condition) but did not affect other measures of emotional distress. The intervention also increased participants' reports that having breast cancer had made positive contributions to their lives, and it increased generalized optimism. Both remained significantly elevated at a 3-month follow-up of the intervention. Further analysis revealed that the intervention had its greatest impact on these 2 variables among women who were lowest in optimism at baseline. Discussion centers on the importance of examining positive responses to traumatic events--growth, appreciation of life, shift in priorities, and positive affect-as well as negative responses.
A longitudinal study was conducted to investigate (a) the timing and course of posttraumatic growth and (b) the relations between positive and negative life changes and posttraumatic distress among recent female sexual assault survivors (N = 171). Most survivors reported positive change even at 2 weeks postassault. Positive changes generally increased over time and negative changes decreased, although change in different domains followed different courses and there was significant individual variability in change patterns. Both positive and negative changes were associated with distress in expected ways, although the relations with negative changes were stronger. The least distress at 12 months was reported by those who noted positive life changes at both 2 weeks and 12 months postassault. Implications for theory and research on posttraumatic growth are discussed.
Recent literature has indicated the need for rapid evaluation of psychosocial issues secondary to cancer. Because of the problems of routine use of psychometric instruments, short instruments such as visual analogue scales or one-item 0-10 scales have been developed as valid assessment alternatives.
A study was conducted to examine the role of two 0-10 scales in measuring emotional stress (distress thermometer, DT) and depressed mood (mood thermometer, MT), respectively, in a multicenter study carried out in southern European countries (Italy, Portugal, Spain, and Switzerland). A convenience sample of 312 cancer outpatients completed the DT and MT and the Hospital Anxiety Depression Scale (HADS).
DT was more significantly associated HADS anxiety than HADS depression while MT was related both to HADS anxiety and depression. The correlation of MT with HADS was higher than DT. A cutoff point >4 on the DT maximized sensitivity (65%) and specificity (79%) for general psychosocial morbidity while a cutoff >5 identified more severe "caseness" (sensitivity=70%; specificity=73%). On the MT, sensitivity and specificity for general psychosocial morbidity were 85% and 72% by using the cutoff score >3. A score >4 on the MT was associated with a sensitivity of 78% and a specificity of 77% in detecting more severe caseness.
Two simple instruments, the DT and the MT, were found to have acceptable levels of sensitivity and specificity in detecting psychosocial morbidity. Compared to the HADS, however, the mood MT performed better than the DT.
There is growing recognition that the experience of cancer can have a positive as well as a negative psychological impact. This longitudinal study sought to identify predictors of posttraumatic growth among cancer patients (N=72) undergoing bone marrow transplantation. Greater posttraumatic growth in the posttransplant period was related to younger age; less education; greater use of positive reinterpretation, problem solving, and seeking alternative rewards as coping strategies in the pretransplant period; more stressful appraisal of aspects of the transplant experience; and more negatively biased recall of pretransplant levels of psychological distress. Findings partially support J. A. Schaefer and R. H. Moos's (1992) model of life crises and personal growth and also suggest that temporal self-comparisons contribute to the experience of posttraumatic growth.
Positive psychological or personal changes in the aftermath of trauma, defined as the result of the struggle with highly stressful events, have recently elicited heightened attention by trauma researchers. This article aims at summarizing the most important theoretical models and conceptualizations of posttraumatic growth (PTG) and addresses the issue of the adaptive significance of this phenomenon. It further renders a thorough empirical review of the relationship between PTG and psychological adjustment. European findings are specifically incorporated. As a conclusion, a two component cognitive model of PTG will be proposed that may explain the contradicting empirical findings in regard to the relationship between mental health and PTG. The Janus-Face model of PTG [Maercker, A. and Zoellner, T. (2004). The Janus face of self-perceived growth: Toward a two-component model of posttraumatic growth. Psychological Inquiry, 15, 41-48.] incorporates a constructive and an illusory aspect. On this basis, findings regarding relevant cognitive factors as predictors of PTG are summarized and evaluated. The article ends with a discussion of fruitful future research directions and how PTG can add a new perspective into trauma therapy.
Two previously studied cohorts of women with nonmetastatic breast cancer (Ns = 230 and 136) were reexamined. Participants were assessed during the year after surgery and 5-8 years later. Associations were examined between benefit finding (BF) and several indicators of psychosocial adjustment (e.g., perceived quality of life, positive affect, negative affect, social disruption, and intrusive thoughts). Significant curvilinear relations between BF and other outcomes were observed cross-sectionally during initial assessment and at long-term follow-up in both samples. Compared with the intermediate BF group, low and high BF groups had better psychosocial adjustment. Further analyses indicated that the high BF group reported higher optimism and more use of positive reframing and religious coping than the other BF groups. Discussion highlights the need to examine nonlinear as well as linear relationships.
Posttraumatic growth (PTG), the phenomenon of self-reported positive outcomes of trauma, is assumed to consist of two sides: a constructive and an illusory side. This study investigates the relationship between PTG and its possible illusory and constructive predictors, as well as the moderating role of posttraumatic stress disorder (PTSD) severity. One-hundred two motor vehicle accident (MVA) survivors with full, subsyndromal, and without PTSD were assessed by multiple psychometric measures targeting PTSD severity, posttraumatic growth, optimism, and openness to experience. Hierarchical regression analysis yielded differential interaction effects between PTSD severity and optimism, as well as openness facets pointing to the moderating role of PTSD severity in the prediction of an illusory and a constructive factor in PTG.
Objective:
Cognitive-behavioral stress management (CBSM) improves adaptation to primary treatment for breast cancer (BCa), evidenced as reductions in distress and increases in positive affect. Because not all BCa patients may need psychosocial intervention, identifying those most likely to benefit is important. A secondary analysis of a previous randomized trial tested whether baseline level of cancer-specific distress moderated CBSM effects on adaptation over 12 months. We hypothesized that patients experiencing the greatest cancer-specific distress in the weeks after surgery would show the greatest CBSM-related effects on distress and affect.
Methods:
Stages 0-III BCa patients (N = 240) were enrolled 2-8 weeks after surgery and randomized to either a 10-week group CBSM intervention or a 1-day psychoeducational (PE) control group. They completed the Impact of Event Scale (IES) and Affect Balance Scale (ABS) at study entry, and at 6- and 12- month follow-ups.
Results:
Latent Growth Curve Modeling across the 12-month interval showed that CBSM interacted with initial cancer-related distress to influence distress and affect. Follow-up analyses showed that those with higher initial distress were significantly improved by CBSM compared to control treatment. No differential improvement in affect or intrusive thoughts occurred among low-distress women.
Conclusion:
CBSM decreased negative affect and intrusive thoughts and increases positive affect among post-surgical BCa patients presenting with elevated cancer-specific distress after surgery, but did not show similar effects in women with low levels of cancer-specific distress. Identifying patients most in need of intervention in the period after surgery may optimize cost-effective cancer care.
Being diagnosed with and treated for cancer is highly stressful and potentially traumatic. An extensive literature has evaluated the prevalence, predictors, and correlates of cancer-related post-traumatic stress disorder (PTSD) symptoms and diagnoses. In this qualitative review of cancer-related PTSD literature, we highlight conceptual, methodological, and diagnostic issues, and identify clinical implications and areas for future research. Cancer-related PTSD has been documented in a minority of patients with cancer and their family members, is positively associated with other indices of distress and reduced quality of life, and has several correlates and risk factors (eg, prior trauma history, pre-existing psychiatric conditions, poor social support). The literature on treatment of cancer-related PTSD is sparse. Existing literature on cancer-related PTSD has used DSM-IV-TR diagnostic criteria; the revised DSM-5 PTSD criteria have important implications for the assessment of cancer-related distress. Application of PTSD diagnosis to patients with cancer has been critiqued on conceptual and methodological grounds, and important differential diagnosis considerations should be taken into account. Psychosocial assessment of patients with cancer should include careful evaluation of pre-cancer diagnosis trauma and psychiatric history, and diagnostic interviewing should consider concurrent conditions (eg, adjustment disorder). Treatment of cancer-related PTSD should be approached with caution and be informed by existing evidence-based approaches for traumatic stress.
Objectives:
The objectives of the current study were to identify (a) different post cancer treatment adaptation profiles; (b) factors that predict these adaptation profiles; and (c) transitions in post cancer-treatment adaptation profiles and trajectories in a sample (N = 198) of female breast cancer patients over a 2-year period.
Method:
Latent class analysis (LCA) was used to idenitfy profiles of post cancer treatment adaptation, based on a combined pattern of responses to observable indicators of distress, coping strategies, and posttraumatic growth. latent transition analysis (LTA) was used to track trajectories, based on the probabilities of transitions among latent classes.
Results:
Four postcancer treatment adaptation profiles were found: (a) distressed, (b) resistant, (c) constructive growth, and (d) struggling growth.
Conclusions:
The majority of transitions between different adaptation profiles occurred between 6 and 12 months after treatment. These findings offer theoretical and practice implications regarding posttraumatic growth in breast-cancer patients by distinguishing between profiles of adaptation and highlights a previously unidentified profile-struggling growth. These results contribute to the theoretical understanding of the complex relationship between growth, distress, and coping. (PsycINFO Database Record
This paperback edition is a reprint of the 2000 edition.
This book provides a comprehensive treatment of linear mixed models for continuous longitudinal data. Next to model formulation, this edition puts major emphasis on exploratory data analysis for all aspects of the model, such as the marginal model, subject-specific profiles, and residual covariance structure. Further, model diagnostics and missing data receive extensive treatment. Sensitivity analysis for incomplete data is given a prominent place. Several variations to the conventional linear mixed model are discussed (a heterogeity model, conditional linear mixed models). This book will be of interest to applied statisticians and biomedical researchers in industry, public health organizations, contract research organizations, and academia. The book is explanatory rather than mathematically rigorous. Most analyses were done with the MIXED procedure of the SAS software package, and many of its features are clearly elucidated. However, some other commercially available packages are discussed as well. Great care has been taken in presenting the data analyses in a software-independent fashion.
Geert Verbeke is Professor in Biostatistics at the Biostatistical Centre of the Katholieke Universiteit Leuven in Belgium. He is Past President of the Belgian Region of the International Biometric Society, a Board Member of the American Statistical Association, and past Joint Editor of the Journal of the Royal Statistical Society, Series A (2005--2008). He is the director of the Leuven Center for Biostatistics and statistical Bioinformatics (L-BioStat), and vice-director of the Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), a joint initiative of the Hasselt and Leuven universities in Belgium.
Geert Molenberghs is Professor of Biostatistics at Universiteit Hasselt and Katholieke Universiteit Leuven in Belgium. He was Joint Editor of Applied Statistics (2001-2004) and Co-Editor of Biometrics (2007-2009). He was President of the International Biometric Society (2004-2005), and has received the Guy Medal in Bronze from the Royal Statistical Society and the Myrto Lefkopoulou award from the Harvard School of Public Health. He is founding director of the Center for Statistics and also the director of the Interuniversity Institute for Biostatistics and statistical Bioinformatics.
Both authors have received the American Statistical Association's Excellence in Continuing Education Award in 2002, 2004, 2005, and 2008. Both are elected Fellows of the American Statistical Association and elected members of the International Statistical Institute.
El objetivo de este estudio es averiguar las propiedades psicométricas de la adaptación española del Inventario de Crecimiento Postraumático (PTGI) en una muestra de pacientes oncológicos ambulatorios (N= 130). El cuestionario permite valorar los cambios positivos que pueden percibirse tras un acontecimiento traumático como es el diagnostico o tratamiento de una enfermedad onco/ógica. Aplicamos un análisis factorial de componentes principales seguido de un análisis con el modelo de ecuaciones estructurales para contrastar la estructura factorial. Realizamos una comparación de medias y análisis correlacional entre las puntuaciones del PTGI y caracferlsticas socio demográficas o médicas. Del análisis de componentes principales extraemos 4 factores que explican el 71 % de la varianza total, del modelo de ecuaciones estructurales se corrobora la estructura monofactorial del cuestionario (Xl= 57,53; p= 0,06) que da cuenta del 54,47% de la varianza. No aparecen diferencias significativas al comparar crecimiento postraumático con género, tratamiento médico recibido y estadio de la enfermedad. Tampoco las correlaciones son significativas entre el PTGI y edad, tiempo desde el diagnóstico o malestar emocional. El inventario de crecimiento postraumático permite evaluar la percepción de cambios positivos tras el diagnóstico o tratamiento de una enfermedad onco/ógica, aunque en la muestra de este estudio el cambio no se define según la dímensionalidad propuesta por los autores del cuestionario.
Resumen Las enfermedades graves como el cáncer, aunque generan elevado malestar emocional y estrés en los super-vivientes y en sus otros signiicativos, también pueden suponer un estímulo en la generación de crecimiento postraumático en ambos. Los mecanismos de cómo se produce este crecimiento postraumático (vicario vs. secundario) en los otros signiicativos no se han estudiado. En esta revisión se analizan la evidencia y relación del crecimiento post-traumático en supervivientes de cáncer y en sus otros signiicativos, princi-palmente sus parejas, madres y padres, en relación a estos mecanismos de transmisión vicario o secundario. Se concluye que, en general, el crecimiento post-traumático en los otros signiicativos es una experiencia vicaria íntimamente ligada al crecimiento del superviviente en cáncer, aunque ser mujer, madre o sufrir un cáncer avanzado facilitan procesos de crecimiento post-traumático secundario en los otros signiicativos, que se diferencian del superviviente. Palabras clave: crecimiento post-traumático vicario, crecimiento post-traumático secundario, otros signiicativos, parejas, padres. Abstract Severe diseases such as cancer although generate high stress and emotional distress in survivors and their signiicant others, can also be a stimulus to promote posttraumatic growth. The mechanisms of this post-traumatic growth (vicarious vs secondary) in signiicant others have not been studied. This review examines the evidence and relationship between posttraumatic growth in cancer survivors and their signiicant others, mainly in their partners and parents, regarding these vicarious or secondary growth transmission mechanisms. We conclude that, in general, posttraumatic growth in signiicant others is a vicarious experience closely linked to the cancer survivor's growth. However, being a woman, mother or suffer an advanced cancer facilitate secondary posttraumatic growth processes insigniicant others.
Linear mixed-effect models (LMMs) are an important class of statistical models that can be used to analyze correlated data. Such data are encountered in a variety of fields including biostatistics, public health, psychometrics, educational measurement, and sociology. This book aims to support a wide range of uses for the models by applied researchers in those and other fields by providing state-of-the-art descriptions of the implementations of LMMs in R. To help readers to get familiar with the features of the models and the details of carrying them out in R, the book includes a review of the most important theoretical concepts of the models. The presentation connects theory, software and applications. It is built up incrementally, starting with a summary of the concepts underlying simpler classes of linear models like the classical regression model, and carrying them forward to LMMs. A similar step-by-step approach is used to describe the R tools for LMMs. All the classes of linear models presented in the book are illustrated using real-life data. The book also introduces several novel R tools for LMMs, including new class of variance-covariance structure for random-effects, methods for influence diagnostics and for power calculations. They are included into an R package that should assist the readers in applying these and other methods presented in this text.
Objective:
People commonly report growth after adversity. Can psychosocial intervention facilitate posttraumatic growth (PTG)?
Method:
This meta-analysis assesses the relationship between intervention participation and PTG using published and unpublished reports located with the database PsycINFO. Eligible studies included randomized controlled trials (k = 12) that provided a psychosocial intervention to people who had experienced an identifiable hardship or trauma (N = 1,171). None of these interventions were specifically designed to promote PTG as a primary outcome.
Results:
The overall controlled effect size (Hedges's g) of 0.36 (95% CI [0.23, 0.48]), using a fixed effects model, suggests that current interventions modestly increase PTG. Moderation analyses revealed little about the factors that increase interventions' effect on PTG, indicating only that interventions that administered the posttest soon after treatment tended to show larger effect sizes.
Conclusions:
Overall, these estimates may be unreliable due to the small number of eligible studies and the varied types of interventions tested, but they suggest that active intervention can help people make the most of adversity.
Empirical studies of the relationship between posttraumatic growth (PTG) and adjustment outcomes reveal a fairly inconclusive picture. We argue that the inconsistent findings are likely due to the heterogeneity of the PTG experience over time. In this regard, we predicted that individuals with different PTG trajectories vary in the level of adjustment and the correlational patterns between PTG and adjustment.
Participants were 124 Taiwanese women who underwent surgery for breast cancer. Measures of PTG and adjustment variables, including positive affect, negative affect, mental and physical quality of life, anxiety, and depression, were assessed at 1 day and 3, 6, and 12 months after surgery. A group-based trajectory model was used to identify subpopulations of individuals who shared homogenous growth patterns. Then, we determined whether the trajectory predicted adjustment at 12 months after surgery. The correlations between PTG and adjustment outcomes were computed in each subpopulation across every time point.
The patients were categorized into the following four groups, which showed very different patterns of PTG change over the first year after breast cancer surgery: stable high (27.4%), high decreasing (39.4%), low increasing (16.9%), and low decreasing (16.9%). Differences in the level of adjustment at 12 months and the patterns of the correlations across time were found among these latent subgroups CONCLUSIONS: This study was the first longitudinal examination of PTG trajectories and their different levels of adjustment. The findings support our argument that identifying distinct PTG trajectories can better determine the nature of the relationship between PTG and adjustment. Copyright © 2014 John Wiley & Sons, Ltd.
This study examined the relation of perceived social support and coping to positive adaptation to breast cancer. Participants were 56 women between the ages of 38 and 58 who had been diagnosed with Stage I or II breast cancer from 1 to 26 months earlier. Social support was measured with the Social Provisions Scale (Cutrona, C. and Russell, D. (1987). The provisions of social relationships and adaptation to stress. In: Jones, W.H. and Perlman, D. (Eds.), Advances in Personal Relationships , Vol. 1, pp. 37-67, JAI Press, Greenwich, CT) and coping was measured with the revised Ways of Coping Scales (Folkman, S., Lazarus, R.S., Dunkel-Schetter, C., DeLongis, A. and Gruen, R. (1986). The dynamics of a stressful encounter: cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology , 50 , 992-1003). Adjustment was measured with the Scales of Psychological Well-Being (Ryff, C.D. (1989). Happiness is everything, or is it? explorations on the meaning of psychological well being. Journal of Personality and Social Psychology , 57 , 1069-1081) and frequency of positive health behaviors. Results showed that perceived social support and approach coping strategies were associated with positive adjustment. Avoidance coping strategies were negatively related to psychological well-being but were unrelated to positive health behaviors. The results of an exploratory path analysis were consistent with a direct relation and an indirect relation through approach coping of social support with psychological well-being.
Objective:
This randomized controlled trial examines whether a briefer cognitive-behavioural (CBT) stress management intervention than the norm can reduce stress and distress and enhance benefit finding in women with breast cancer. It further aims to identify characteristics of those women most likely to benefit from the intervention.
Design and method:
A randomized controlled trial was conducted to assess the efficacy of a psychological intervention. Women (N = 355) who had undergone surgery for breast cancer 4 months earlier, the majority of whom were currently undergoing adjuvant therapy, completed questionnaires assessing global and cancer-specific stress, depression, anxiety, optimism and benefit finding. They were randomly assigned to a 5-week group cognitive-behavioural stress management (CBSM) programme plus standard care or standard care only. Reassessment occurred post-intervention and 12 months later.
Results:
Analyses of variance revealed that patients who received the intervention showed significant lowering of global stress and anxiety and increased benefit finding compared to controls. These differences, however, were not maintained at 12 months. Effects of the intervention were moderated by stress such that women with high global stress at baseline showed greater reduction in both stress and anxiety.
Conclusions:
A CBSM intervention, which was briefer than the norm (5 weeks vs. 9-20 weeks), had beneficial effects on adjustment for women with breast cancer and was particularly effective for those with increased global stress. Screening on this basis may facilitate optimal and cost-effective psychological treatment.
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Background:
A diagnosis of breast cancer and treatment are psychologically stressful events, particularly over the first year after diagnosis. Women undergo many demanding and anxiety-arousing treatments such as surgery, radiation and chemotherapy. Psychosocial interventions that promote psychosocial adaptation to these challenges may modulate physiological processes (neuroendocrine and immune) that are relevant for health outcomes in breast cancer patients.
Methods:
Women with Stages 1-3 breast cancer recruited 4-8 weeks after surgery were randomized to either a 10-week group-based cognitive behavioral stress management (CBSM) intervention or a 1-day psychoeducational control group and completed questionnaires and late afternoon blood samples at study entry and 6 and 12 months after assignment to experimental condition.
Results:
Of 128 women initially providing psychosocial questionnaire and blood samples at study entry, 97 provided complete data for anxiety measures and cortisol analysis at all time points, and immune assays were run on a subset of 85 of these women. Those assigned to a 10-week group-based CBSM intervention evidenced better psychosocial adaptation (lower reported cancer-specific anxiety and interviewer-rated general anxiety symptoms) and physiological adaptation (lower cortisol, greater Th1 cytokine [interleukin-2 and interferon-gamma] production and IL-2:IL-4 ratio) after their adjuvant treatment compared to those in the control group. Effects on psychosocial adaptation indicators and cortisol appeared to hold across the entire 12-month observation period. Th1 cytokine regulation changes held only over the initial 6-month period.
Conclusions:
This intervention may have facilitated a "recovery or maintenance" of Th1 cytokine regulation during or after the adjuvant therapy period. Behavioral interventions that address dysregulated neuroendocrine function could play a clinically significant role in optimizing host immunologic resistance during a vulnerable period.
The study of posttraumatic growth (PTG) has burgeoned over the last decade, particularly in the area of oncology. The aims of the study were to: (1) describe PTG in patients with hepatobiliary carcinoma, (2) examine agreement between the patient and caregiver measures of patient PTG, and (3) test the associations between PTG and other psychological factors and clinically relevant outcomes.
Two hundred and two patients with hepatobiliary carcinoma completed a battery of standardized questionnaires that measured PTG, depressive symptoms, optimism, expressed emotion, and quality of life (QOL). A subsample of family caregivers also completed ratings of patient PTG, using the Posttraumatic Growth Inventory (PTGI), as well as their own PTG.
No significant increase in the patients' PTG was observed between diagnosis and 6-month follow-up with the exception of the Relating to Others subscale of the PTGI. PTG was not found to be associated with QOL or depressive symptoms. At diagnosis, the agreement between the patients' PTG and family caregivers' rating of patient PTG was found to be high (ICC=0.34-0.74, p=0.001-0.05). PTG was found to be significantly associated with optimism (r=0.20 p=0.02-0.05) and traumatic life events reported in the past 3 years, including recent losses (F(1, 52)=6.0, p=0.02) and severe physical injury (F(1, 52)=5.5, p=0.02). Caregivers reported PTG as a result of their loved one's diagnosis of cancer.
Preliminary results suggest that PTG is relatively stable over the first 6 months after diagnosis and changes as a result of a diagnosis of cancer were reported, and possibly observed, by others. Family caregivers also experience PTG as a result of their loved one's diagnosis of advanced cancer.
As advances in cancer screening and treatment increase the number of long-term cancer survivors, it is important to understand the long-term psychological sequelae of the cancer experience.
The 4636 respondents who identified themselves as survivors of adult-onset cancer of 5 years or more and 122 220 respondents who were never diagnosed as having cancer were identified in the 2002 to 2006 National Health Interview Survey. The primary outcome in this population-based study was serious psychological distress (SPD) defined as a K6 scale (a validated screening tool for mental illness) score of 13 or more.
Among survivors, the median age at diagnosis was 50 years, the age at interview was 66 years, and the time since diagnosis was 12 years. The prevalence of SPD was significantly higher among long-term cancer survivors than among respondents who were never diagnosed as having cancer (5.6% vs 3.0%; P < .001). After adjustment for clinical and sociodemographic variables (age, sex, race, relationship status, educational attainment, insurance status, comorbidities, smoking history, and ability to perform instrumental activities of daily living), survivors remained significantly more likely to experience SPD (adjusted odds ratio, 1.4; 95% confidence interval, 1.2-1.7). After adjustment for other clinical and sociodemographic variables, long-term survivors who were younger, were unmarried, had less than a high school education, were uninsured, had more comorbidities, or had difficulty performing instrumental activities of daily living were more likely to experience SPD.
Long-term survivors of adult-onset cancer are at increased risk for psychological distress. This study identifies several clinical and sociodemographic factors associated with SPD that may help target high-risk survivors for psychological screening and support.
Research in posttraumatic growth (PTG) among cancer patients has been triggered primarily by the inclusion of serious illnesses among the events that can lead to posttraumatic stress disorder (PTSD); increasing survival rates among cancer patients; and, attempts at encouraging a positive psychology that focuses on a patient's ability to fight adversity. The difficulties encountered in clearly defining the processes associated with this subjective feeling of growth following recovery raise doubts concerning the real or illusory nature of the phenomenon and its adaptative value. This paper explains why cancer may be different than other traumas and why PTG may interact with this ecology of circumstances in different ways. Difficulty in identifying a single stressor, the internal source of the event, cancer as a future, ongoing and chronic integration threat, and greater perceived control differences between cancer and others traumas. This review brings together the latest studies of PTG in cancer, and focuses in the debate of the real or illusory nature of the PTG and his adaptative value. The ongoing threat, uncertainty and vulnerability associated with cancer are the variables that have been related most consistently with PTG and tend to confuse the relationship between PTG and emotional well-being, too.
In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
The aim of this study was to investigate the hypothesis that, independent of other known prognostic factors, pessimistic head and neck (H&N) cancer patients have a greater risk of being dead 1 year after diagnosis than do optimistic patients.
A prospective observational study design was used with a cohort of H&N cancer patients diagnosed during the period from March 1, 1997, to August 31, 1998, at the Centre Hospitalier Universitaire, Clermont-Ferrand, France. Dispositional optimism (DO) was evaluated at baseline using a French version of the Life Orientation Test translated and validated for this study. One-year survival status was collected on all subjects. The analysis of the hypothesized association between DO and 1-year survival was performed using multiple logistic regression analysis, controlling for other sociodemographic and clinical variables.
The sample size was 101 patients, representing all but one of those patients fitting the inclusion criteria who were diagnosed during the recruitment period. Of these, 51 were alive at 1 year after diagnosis, 45 were dead, and five were lost to follow-up. The multivariate analysis was performed on the data from the 96 subjects in whom 1-year survival status was known. Controlling for known predictors of H&N cancer survival, pessimistic subjects (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.01 to 1.24) and those living alone (OR, 4.14; 95% CI, 1.21 to 14.17) were more likely than optimistic subjects and those living with others to be dead at 1 year.
The results of this study of a cohort of French H&N cancer patients indicate that dispositional optimism predicts 1-year survival independent of other sociodemographic and clinical variables.
The current study evaluated the efficacy of a 10-week, group-based, cognitive-behavioral stress management (CBSM) intervention relative to a half-day seminar in improving quality of life (QoL) among men who were treated for localized prostate carcinoma (PC) with either radical prostatectomy (RP) or radiation therapy.
Ninety-two men were assigned randomly to either the 10-week CBSM group intervention or a 1-day seminar (control group). The intervention was designed to improve QoL by helping participants to identify and effectively manage stressful experiences and was focused on the treatment-related sequelae of PC.
A hierarchical regression model was used to predict postintervention QoL. The final model, including all predictors and relevant covariates (i.e., income, baseline QoL, ethnicity, and group condition), explained 62.1% of the variance in QoL scores. Group assignment was a significant predictor (beta = - 0.14; P = 0.03) of QoL after the 10-week intervention period, even after controlling for ethnicity, income, and baseline QoL. Post-hoc analyses revealed that individuals in the CBSM intervention condition showed significant improvements in QoL relative to men in the 1-day control seminar. Improved QoL was mediated by greater perceived stress-management skill.
A 10-week cognitive-behavioral group intervention was effective in improving the QoL in men treated for PC, and these changes were associated significantly with intervention-associated increases in perceived stress-management skills.
A number of literatures and philosophies throughout human history have conveyed the idea that there is personal gain to be found in suffering, and it is an idea central to the existential-humanistic tradition of psychology. However, it is only relatively recently that the topic of growth following adversity has become the focus for empirical and theoretical work. In this paper, we review theoretical models of growth, and discuss the implications of growth for clinical practice. Three main theoretical perspectives are reviewed, the functional-descriptive model, the meta-theoretical person-centered perspective, and the biopsychosocial-evolutionary view. It is proposed that these three approaches to theory offer different but complementary levels of analysis, and that theoretical integration between them is possible. We then go on to explore the implications of this theoretical integration for clinical practice, and conclude with a consideration of the role of therapy in facilitating growth following adversity.
Recent literature has indicated that a significant percentage of oncology patients describe finding some benefit (e.g., improved personal growth, sense of meaning, and enhanced interpersonal relationships) in the cancer experience. However, few studies have investigated the role of group-based psychosocial interventions in improving benefit finding (BF), and virtually none have investigated these constructs in men.
This study examined whether a cognitive-behavioral stress management (CBSM) intervention improves BF and quality of life (QoL) in men recovering from treatment for localized prostate cancer.
Participants in this study were 191 men (M age = 65.1) treated with radiation or radical prostatectomy for clinically localized (i.e., Stage I or II) prostate cancer. Participants were primarily non-Hispanic White (40%) or Hispanic (41%), followed by Black (18%) and other ethnicity (1%), were an average of 65.1 years old (SD = 7.7), and earned an average of 47,800 US dollars annually (SD = 41,000 US dollars). Participants were randomized to either a 10-week group-based cognitive-behavioral stress management intervention or a half-day educational seminar as a control condition. All participants provided demographic information and completed the Positive Contributions Scale-Cancer to assess BF, the Functional Assessment of Cancer Therapy to measure quality of life, and a measure of perceived stress management skills. Structural equation modeling was utilized for all analyses.
Results indicated that the CBSM condition led to increases in BF and QoL and that these changes were mediated by the development of stress management skills.
Results support the use of group-based cognitive-behavioral interventions in promoting QoL and BF in this population.
This study aimed at the identification of acute and post-traumatic stress responses, and comorbid mental disorders in breast cancer patients. Structured clinical interviews for DSM-IV (SCID) were conducted post-surgery with 127 patients (t1). Screening measures were used to assess post-traumatic stress responses, anxiety, and depression at t1 and at 6 months follow-up (t2). Based on the SCID, prevalence rates were 2.4% for both, cancer-related ASD and PTSD. Experiences most frequently described as traumatic were the cancer diagnosis itself and subsequent feelings of uncertainty. Patients with lifetime PTSD (8.7%) were more likely to meet the criteria for cancer-related ASD or PTSD (OR=14.1). Prevalence estimates were 7.1% for Adjustment Disorder, 4.7% for Major Depression, 3.1% for Dysthymic Disorder and 6.3% for Generalized Anxiety Disorder. Using the screening instruments, IES-R, PCL-C and HADS, we found PTSD in 18.5% at t1 and 11.2-16.3% at t2. The estimates of anxiety and depression reveal rates of 39.6% (t1) and 32.7% (t2) for anxiety, as well as 16.0% (t1) and 13.3% (t2) for depression (t1) (cut-off> or =8). The diagnosis of a life-threatening illness has been included as a potential trauma in the DSM-IV. However, it has to be critically evaluated whether subjective feelings of uncertainty like fears of treatment count among traumatic stressors, and thus, whether the diagnosis of PTSD is appropriate in this group of cancer patients. However, a large number of women with emotional distress illustrate the need for psychosocial counseling and support in this early treatment phase.
Diagnostic and statistical manual of mental disorders
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.).