Dispositional optimism as a predictor of men's decision-related distress after localized prostate cancer.

This study investigated prospectively the relationship between optimism, threat appraisal, seeking support and information, cognitive avoidance, physical treatment side effects, and decision-related distress in 111 men with localized prostate cancer. Men were assessed at diagnosis and 2 and 12 months after treatment. Baseline decision-related distress predicted distress 2 and 12 months after treatment. Optimism was a significant prospective and concurrent predictor of decision-related distress, with the effect mediated by proximal cancer threat appraisal. Seeking support and information and cognitive avoidance were not associated with decision-related distress at any time point. For physical treatment side effects, concurrent urinary symptoms were predictive of decision-related distress 2 months after treatment. Results suggest that decision-related distress is generated by similar processes to that of the psychological distress that follows a cancer diagnosis. Screening for men with high decision-related distress for referral to in-depth decision support is suggested. Outcome expectations may present as a therapy target to increase the effectiveness of decisional support that is utility based. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of social support and problematic support on optimism and depression in chronic illness: A prospective study evaluating self-esteem as a mediator.

The present study focused on the mechanism through which social and problematic support affects psychological adjustment in chronic illness. The authors hypothesized that self-esteem would mediate the relations between social and problematic support and adjustment. Eighty-six end-stage renal disease patients were assessed twice for social support, problematic support, and self-esteem. Adjustment was assessed twice by depression and optimism. Mediational analyses indicated that social support operated through self-esteem to influence optimism cross-sectionally and prospectively and depression cross-sectionally. Social support was associated with high self-esteem, which in turn increased optimism and was related to decreased depression. Problematic support was unrelated to self-esteem obviating mediational analysis. Disaggregating social support into subscales showed that belonging support predicted decreases in depression, and both tangible and belonging support predicted increases in optimism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Survivors of childhood cancer and comparison peers: The influence of early family factors on distress in emerging adulthood.

This prospective study examines family predictors of distress among survivors of childhood cancer and comparison peers during the transition to emerging adulthood. Children with cancer (n = 55), comparison peers (n = 60), and parents completed measures of distress, family environment, social support, and demographic characteristics during initial treatment, as well as follow-up measures of young adult distress and demographic characteristics soon after participants turned 18 years old. Severity of initial treatment and late effects were rated by healthcare providers for participants with cancer. For all participants, mother and father report of initial parent distress was associated with their report of young adult distress at follow-up. Young adult gender moderated this association. For survivors of childhood cancer, severity of initial treatment and late effects also moderated the association between parent and young adult distress. Improving parent distress may help reduce child distress in general. For survivors specifically, ameliorating the impact of initial treatment and long-term physical problems may be beneficial. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting posttraumatic growth in breast cancer survivors.

Wide variability exists with respect to how breast cancer survivors respond to common psychological and psychosocial challenges of their disease, ranging from posttraumatic stress disorder to posttraumatic growth. This cross-sectional study examined contextual, disease-related, and intraindividual predictors of posttraumatic growth in 224 randomly selected breast cancer survivors. A series of hierarchical regression analyses found that age at diagnosis, marital status, employment, education, perceived intensity of disease, and active coping accounted for 34%, 35%, and 28% of the variance in growth in relationships with others, new possibilities, and appreciation for life. These findings suggest that a more comprehensive model of growth will be helpful in understanding the various factors that play a role in breast cancer survivors' perception of psychological and psychosocial growth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internet use and social support in women with breast cancer.

Many Web sites offer information to breast cancer patients, who are increasingly using these sites. The authors investigated the potential psychological benefits of Internet use for medical information by breast cancer patients. Of the 251 women approached, 188 were successfully interviewed (74.9%). Forty-two percent used the Internet for medical information related to breast health issues and did so for an average of 0.80 hr per week. The Interpersonal Support Evaluation List and the UCLA Loneliness Scale, with results controlled for covariates, showed that Internet use for breast health issues was associated with greater social support and less loneliness than Internet use for other purposes or nonuse. Breast cancer patients may obtain these psychological benefits with only a minimal weekly time commitment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional distress following genetic testing for hereditary breast and ovarian cancer: A meta-analytic review.

Objective: Meta-analysis was used to synthesize results of studies on emotional consequences of predictive genetic testing for BRCA1/2 mutations conferring increased risk of breast and ovarian cancer. Design: Studies assessing anxiety or cancer-specific distress before and after provision of test results (k = 20) were analyzed using a random-effects model. Moderator variables included country of data collection and personal cancer history of study participants. Main Outcome Measures: Standardized mean gain effect sizes were calculated for mutation carriers, noncarriers, and those with inconclusive results over short (0–4 weeks), moderate (5–24 weeks), or long (25–52 weeks) periods of time after testing. Results: Distress among carriers increased shortly after receiving results and returned to pretesting levels over time. Distress among noncarriers and those with inconclusive results decreased over time. Some distress patterns differed in studies conducted outside the United States and for individuals with varying cancer histories. Conclusion: Results underscore the importance of time; changes in distress observed shortly after test-result disclosure frequently differed from the pattern of distress seen subsequently. Although emotional consequences of this testing appear minimal, it remains possible that testing may affect cognitive and behavioral outcomes, which have rarely been examined through meta-analysis. Testing may also affect understudied subgroups differently. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social constraints, cognitive processing, and adjustment to breast cancer.

This cross-sectional study of 70 breast cancer survivors examined relationships among social constraints, behavioral and self-report indicators of cognitive processing, depression, and well-being. On the basis of a social-cognitive processing (SCP) model, it was predicted that social constraints would inhibit cognitive processing of the cancer experience, leading to poorer adjustment. Constraints were positively associated with intrusions, avoidance, and linguistic uncertainty in cancer narratives. Greater uncertainty, intrusions, and avoidance, as well as less talking about cancer were associated with greater depression and less well-being. Intrusions partially mediated the positive constraints-depression relationship. Talking about cancer partially mediated the inverse avoidance-well-being relationship. Findings support the SCP model and the importance of using behavioral indicators of cognitive processing to predict positive and negative psychosocial outcomes of cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social connectedness, dysfunctional interpersonal behaviors, and psychological distress: Testing a mediator model.

The study examined the relationship among social connectedness, dysfunctional interpersonal behaviors, and psychological distress. The authors specifically hypothesized that the direct negative effect of social connectedness on psychological distress would be mediated by dysfunctional interpersonal behaviors. Prior to testing the hypothesis, the authors revised the original Social Connectedness Scale (SCS; R. A Lee and S. B. Robbins, 1995). Studies 1 and 2 describe the revision and validation of the SCS on separate samples of college students. In Study 3, the authors surveyed 194 college students and found support for the mediation hypothesis on general psychological distress. The importance of assessing social connectedness and tailoring counseling interventions for people with low connectedness and dysfunctional interpersonal behaviors is addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification and prediction of distress trajectories in the first year after a breast cancer diagnosis.

Objective: In this article, we aim to (a) identify distinct trajectories of psychological distress in the first year after a breast cancer diagnosis in women treated with adjuvant therapy and (b) explore possible predictors of these trajectories, that is, demographic, medical, and personal characteristics. Method: The 171 patients were assessed after diagnosis, after surgery, after adjuvant treatment, in the reentry phase, and in the (short-term) survivorship phase (2 and 6 months after the end of treatment, respectively). Main Outcome Measure: Psychological distress was assessed with the 12-item General Health Questionnaire. Results: There were four trajectories of distress: a group that experienced no distress (36.3%), a group that experienced distress only in the active treatment phase (33.3%), a group that experienced distress in the reentry and survivorship phase (15.2%), and a group that experienced chronic distress (15.2%). Personality and physical complaints resulting from adjuvant treatment could distinguish the distress trajectories. Mastery was the only unique predictor. Conclusion: Most patients were not distressed in response to breast cancer or only temporarily so. Yet, a minority of patients became or remained distressed after the end of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social-cognitive processes as moderators of a couple-focused group intervention for women with early stage breast cancer.

Objective: The purpose was to examine whether social-cognitive variables would moderate the efficacy of a couple-focused group intervention (CG) for women diagnosed with early stage breast cancer. Design: Participants (N = 238) were randomly assigned to 6 sessions of a couple-focused group versus usual care. Intent to treat growth curve modeling analyses indicated that emotional expression and emotional processing moderated CG effects on depression. Main Outcome Measures: The primary outcome measures for this study were psychological distress and psychological well-being. Results: Treatment attrition analyses separating out participants assigned to but not attending CG indicated that emotional expression, emotional processing, and protective buffering moderated the effects of CG among those who attended CG with the most consistent effects noted for emotional processing on indicators of distress and well-being. Conclusion: The CG intervention may be more effective for patients who begin the group experience using emotional approach coping strategies to deal with cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The overlapping contributions of attachment orientation and social support in predicting life-events distress.

Attachment anxiety, attachment avoidance, and perceived social support are examined as predictors of life-events distress. Clients at initial intake to an addiction treatment centre and university students in their graduating year were administered measures of attachment orientation, social support, and the experience of distressing life events. Hypotheses were tested across different categories of distressing life events (overall distress, bereavement, relationship dissolution, crime victimization, and severe accidents). We found that attachment anxiety and attachment avoidance have varying predictive utility for distress, depending on the type of event. Social support did not account for variance beyond attachment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dispositional pessimism predicts illness-related disruption of social and recreational activities among breast cancer patients.

The authors tested whether dispositional pessimism would predict withdrawal from social activities among women treated for breast cancer. In a cross-sectional sample 3-12 months postsurgery, disruption of social and recreational activities (measured by the Sickness Impact Profile) correlated with concurrently assessed pessimism. This association appeared mediated by emotional distress and fatigue. A longitudinal sample was studied shortly postsurgery and over the next year. Initial pessimism predicted disruption of social activities concurrently and prospectively (3, 6, and 12 months later) but predicted change in disruption from one time to the next only at final follow-up. These associations appeared partially mediated by distress. The authors conclude that pessimism places patients at risk for adverse outcomes in several respects rather than solely with regard to emotional distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spousal support and changes in distress over time in couples coping with cancer: The role of personal control.

This longitudinal study has examined the associations between perceived supportive and unsupportive spousal behavior and changes in distress in couples coping with cancer. We tested whether people relatively low in their sense of personal control were more responsive to spousal supportive and unsupportive behavior than were people relatively high in personal control. Patients with colorectal cancer and their partners (n = 70) completed questionnaires at two assessment points: 3 (at baseline) and 9 months (at follow-up) after the diagnosis. We assessed perceived spousal supportive (SSL) and unsupportive (SSL-N) behavior, sense of personal control (Pearlin & Schooler's Mastery), and depressive symptoms (CES-D) in both patients and partners. Multilevel analysis (MLwiN) was used to examine changes in distress over time in a dyadic context. Patients and partners who perceived more spousal support reported less distress over time, but this only applied to those relatively low in personal control. Moreover, partners who perceived more unsupportive spousal behavior reported more distress, again only if they were relatively low in personal control. Patients and partners relatively high in personal control reported relatively low levels of distress, regardless of spousal behavior. In conclusion, people relatively low in personal control may be more adversely affected by unsupportive behavior and benefit more from supportive behavior than people relatively high in personal control. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social support as a predictor of variability: An examination of the adjustment trajectories of recent widows.

The variability pattern of emotional well-being in recent widows across a 98-day period beginning in the first month post-loss has previously been modeled by dynamical systems and shown to be an oscillating process that damps across time. The goal of the present study was to examine how variables that comprise the social support network predict characteristics of these emotional shifts in 28 recent widows. In the present study, emotional support seeking led to a steeper overall trend, whereas perceived control for social support led to a shallower overall trend. When examining intraindividual variability, instrumental support seeking predicted a slower damping rate. Understanding the individual differences in the variability patterns of recent widows is a necessary step in identifying the etiology of adjustment to widowhood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Partner unsupportive responses, avoidant coping, and distress among women with early stage breast cancer: Patient and partner perspectives.

This 18-month longitudinal study examined the associations among partner unsupportive behavior, avoidant coping, and distress experienced by 219 women with early stage breast cancer. The role of patient and partner ratings of unsupportive behavior were evaluated. Results indicated that patient and partner ratings of unsupportive behavior were highly correlated. Growth curve modeling suggested that unsupportive behavior, from both patient and partner perspectives, predicted more avoidant coping and distress. When partner and patient perceptions were placed in the same model, patient perceptions mediated the association between partners' ratings of their unsupportive behavior and patient distress. Avoidance also mediated the association between unsupportive behavior and distress, extending prior cross-sectional findings. Results highlight the long-term detrimental effects of partners' unsupportive behavior on the quality of life of women with early stage breast cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interdependence in women with breast cancer and their partners: An interindividual model of distress.

Objective: The aim of this investigation was to test whether interdependence in dyads living with breast cancer could account for person–partner crossover effects in distress outcomes. Method: The sample consisted of 95 dyads with early-stage breast cancer. By using reciprocal dyadic data from women with breast cancer and their partners, we fit a structural equation model of the actor–partner interdependence model to examine the interaction of participants’ depression and stress in predicting their partner’s health outcomes. Results: Results revealed a pattern of influence whereby the interaction of high levels of depression coupled with high levels of stress in women with breast cancer was associated with lowered physical health and well-being in their partners. Although depression seemed to be the key mechanism in predicting distressing outcomes, when depression was combined with any additional stress, the level of physical distress was significantly greater. Results provided preliminary empirical support for crossover effects in the physical well-being of close relational partners in a cancer-related context. Further, results showed that distressing outcomes need not be limited to emotional distress but can also include physical distress. Conclusions: The findings from this study illustrate why it is not sufficient to concentrate care solely on the patient with cancer. Monitoring the social well-being of patients as they go through the cancer process could be as important as assessing their psychological state or other peripheral biomarkers. This line of inquiry would be advanced by including methods other than self-report in assessments of psychological and physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of emotionally expressive writing for women with metastatic breast cancer.

Objective: To test the effects of emotionally expressive writing in a randomized controlled trial of metastatic breast cancer patients and to determine whether effects of the intervention varied as a function of perceived social support or time since metastatic diagnosis. Design: Women (N = 62) living with Stage IV breast cancer were randomly assigned to write about cancer-related emotions (EMO; n = 31) or the facts of their diagnosis and treatment (CTL; n = 31). Participants wrote at home for four 20-min sessions within a 3-week interval. Main Outcome Measures: Depressive symptoms, cancer-related intrusive thoughts, somatic symptoms, and sleep quality at 3 months postintervention. Results: No significant main effects of experimental condition were observed. A significant condition × social support interaction emerged on intrusive thoughts; EMO writing was associated with reduced intrusive thoughts for women reporting low emotional support (η2 = .15). Significant condition × time since metastatic diagnosis interactions were also observed for somatic symptoms and sleep disturbances. Relative to CTL, EMO participants who were more recently diagnosed had fewer somatic symptoms (η2 = .10), whereas EMO participants with longer diagnosis duration exhibited increases in sleep disturbances (η2 = .09). Conclusion: Although there was no main effect of expressive writing on health among the current metastatic breast cancer sample, expressive writing may be beneficial for a subset of metastatic patients (including women with low levels of emotional support or who have been recently diagnosed) and contraindicated for others (i.e., those who have been living with the diagnosis for years). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Involvement in decision-making and breast cancer survivor quality of life.

Objective: This study examined the long-term effects on women's health related quality of life (HRQOL) of involvement in decision-making about their treatment for breast cancer and about follow-up care after treatment. Methods: Using a cross-sectional survey design, a sample of breast cancer survivors from Western Washington who were 2, 5, and 10 years postdiagnosis were recruited via a cancer registry and interviewed about their HRQOL and their involvement in decision-making about their cancer treatment and follow-up care. Main Outcome Measures: HRQOL was assessed using the SF-36. Results: Multiple regression analyses examining demographic and disease characteristics revealed age, and education, but not stage of cancer at diagnosis, to be significant predictors of perceived involvement in decision-making about cancer treatment and follow-up. Controlling for demographic and disease characteristics, perceived involvement in decision-making about treatment overall, surgery, chemotherapeutic treatment, and follow-up care were each associated with improved HRQOL, including the general health and vitality subscales of the SF-36 (p     

Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: Response expectancies and emotional distress.

Objective: The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Method: Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years; 63% White, 15% Hispanic, 13% African American, and 9% other) were randomized to a hypnosis or to an attention control group. Prior to surgery, patients completed assessments of hypothesized mediators (response expectancies and emotional distress), and following surgery, patients completed assessments of outcome variables (pain, nausea, and fatigue). Results: Structural equation modeling revealed the following: (a) Hypnotic effects on postsurgical pain were partially mediated by pain expectancy (p p = .12); (b) hypnotic effects on postsurgical nausea were partially mediated by presurgical distress (p = .02) but not by nausea expectancy (p = .10); and (c) hypnotic effects on postsurgical fatigue were partially mediated by both fatigue expectancy (p = .0001) and presurgical distress (p = .02). Conclusions: The results demonstrate the mediational roles of response expectancies and emotional distress in clinical benefits associated with a hypnotic intervention for breast cancer surgical patients. More broadly, the results improve understanding of the underlying mechanisms responsible for hypnotic phenomena and suggest that future hypnotic interventions target patient expectancies and distress to improve postsurgical recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)