Posttraumatic growth following breast cancer: A controlled comparison study.

Cancer may be viewed as a psychosocial transition with the potential for positive and negative outcomes. This cross-sectional study (a) compared breast cancer (BC) survivors' (n?=?70) self-reports of depression, well-being, and posttraumatic growth with those of age- and education-matched healthy comparison women (n?=?70) and (b) identified correlates of posttraumatic growth among BC survivors. Groups did not differ in depression or well-being, but the BC group showed a pattern of greater posttraumatic growth, particularly in relating to others, appreciation of life, and spiritual change. BC participants' posttraumatic growth was unrelated to distress or well-being but was positively associated with perceived life-threat, prior talking about breast cancer, income, and time since diagnosis. Research that has focused solely on detection of distress and its correlates may paint an incomplete and potentially misleading picture of adjustment to cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotionally expressive coping predicts psychological and physical adjustment to breast cancer.

This study tested the hypothesis that coping through emotional approach, which involves actively processing and expressing emotions, enhances adjustment and health status for breast cancer patients. Patients (n ?=?92) completed measures within 20 weeks following medical treatment and 3 months later. Women who, at study entry, coped through expressing emotions surrounding cancer had fewer medical appointments for cancer-related morbidities, enhanced physical health and vigor, and decreased distress during the next 3 months compared with those low in emotional expression, with age, other coping strategy scores, and initial levels on dependent variables (except medical visits) controlled statistically. Expressive coping also was related to improved quality of life for those who perceived their social contexts as highly receptive. Coping through emotional processing was related to one index of greater distress over time. Analyses including dispositional hope suggested that expressive coping may serve as a successful vehicle for goal pursuit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing the validity of self-reported stress-related growth.

The purpose of these studies was to assess the validity of self-reported stress-related growth (SRG). In Study 1, individuals with breast cancer (n = 70) generally did not report greater well-being than a matched comparison group (n = 70). In Study 2, there were no significant differences in well-being between undergraduate students who said that something positive had come out of their worst stressor (n = 34) and those who reported no positives (n = 34). In Study 3, specific domains of SRG assessed in undergraduate students (n = 96) generally were not uniquely related to corresponding well-being measures. Thus, the authors found fairly little evidence for the validity of self-reported SRG. Future research directions are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The yellow brick road and the emerald city: Benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer.

Predictors and outcomes of benefit finding, positive reappraisal coping, and posttraumatic growth were examined using interviews and questionnaires from a longitudinal study of women with early-stage breast cancer followed from primary medical treatment completion to 3 (n=92) and 12 months (n=60) later. Most women (83%) reported at least 1 benefit of their breast cancer experience. Benefit finding (i.e., identification of benefits, number of benefits), positive reappraisal coping, and posttraumatic growth had distinct significant predictors. Positive reappraisal coping at study entry predicted positive mood and perceived health at 3 and 12 months and posttraumatic growth at 12 months, whereas benefit finding did not predict any outcome. Findings suggest that benefit finding, positive reappraisal coping, and posttraumatic growth are related, but distinct, constructs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived Partner Reactions to Diagnosis and Treatment of Breast Cancer: Impact on Psychosocial and Psychosexual Adjustment.

Two studies examined breast cancer patients' perceptions of their partners' reactions to their diagnosis and treatment as influences on 3 aspects of patients' well-being: psychosexual adjustment, emotional distress, and marital satisfaction. Study 1, cross-sectional, indicated that partner initiation of sex, frequency of sex, a positive 1st sexual experience after treatment, and especially perception of the partner's emotional involvement in the relationship, were relevant to these outcomes. Study 2, longitudinal, confirmed many of these findings in prospective tests across 1 year of recovery after surgery. Partner involvement prospectively predicted all 3 outcomes. Partner initiation of sex predicted greater marital satisfaction; partner adverse reaction to the scar predicted less marital satisfaction. Rated quality of the 1st sexual experience after treatment predicted less distress. The pattern suggests that women's impressions of their partners' emotional involvement after surgery for breast cancer forecast their adjustment in sexual, marital, and emotional arenas over the following year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Optimistic Personality and Psychosocial Well-Being During Treatment Predict Psychosocial Well-Being Among Long-Term Survivors of Breast Cancer.

In considering well-being among survivors of life-threatening illnesses such as breast cancer, 2 important questions are whether there is continuity between initial adjustment and longer term adjustment and what role personality plays in long-term adjustment. In this research, a sample of 163 early stage breast cancer patients whose psychosocial adjustment was first assessed during the year after surgery completed the same measures 5-13 years after surgery. Initial reports of well-being were relatively strong predictors of follow-up well-being on the same measures. Initial optimism and marital status also predicted follow-up adjustment, even controlling for earlier adjustment, which exerted a substantial unique effect in multivariate analyses. In contrast, initial medical variables played virtually no predictive role. There is substantial continuity of subjective well-being across many years among survivors of breast cancer, rooted partly in personality and social connection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategies used in coping with a cancer diagnosis predict meaning in life for survivors.

The search for meaning in life is part of the human experience. A negative life event may threaten perceptions about meaning in life, such as the benevolence of the world and one's sense of harmony and peace. The authors examined the longitudinal relationship between women's coping with a diagnosis of breast cancer and their self-reported meaning in life 2 years later. Multiple regression analyses revealed that positive strategies for coping predicted significant variance in the sense of meaning in life--feelings of inner peace, satisfaction with one's current life and the future, and spirituality and faith--and the absence of such strategies predicted reports of loss of meaning and confusion (ps     

Psychological well-being after spinal cord injury: Perception of loss and meaning making.

Objective: This study examined the influence of medical injury severity, perceived loss of physical functioning (conceptualized as physical resource loss), and global meaning making on psychological well-being among 79 veterans living with a spinal cord injury. Measures: Structured interviews were completed to assess perceived loss of physical abilities using the Conservation of Resources—Evaluation and SF-36 Health Survey, global meaning making (Purpose in Life scale), and psychological well-being (Sense of Well-Being Inventory). Medical injury severity was calculated from medical records. Results: Medical injury severity was not related to psychological well-being, whereas perceived loss of physical functioning was inversely associated. Global meaning making was significantly related to and accounted for a large portion of the variance in psychological well-being. Results suggest that global meaning making partially mediates perceived loss of physical resources and psychological well-being. Conclusion: The perceived loss of physical abilities and the generation of meaning and purpose in life are important variables that relate to positive adaptation following spinal cord injury. Treatment implications related to factors that increase quality of life following spinal cord injury are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traumatic Stress, Perceived Global Stress, and Life Events: Prospectively Predicting Quality of Life in Breast Cancer Patients.

The authors investigated the relationship between stress at initial cancer diagnosis and treatment and subsequent quality of life (QoL). Women (n = 112) randomized to the assessment-only arm of a clinical trial were initially assessed after breast cancer diagnosis and surgery and then reassessed at 4 months (during adjuvant treatment) and 12 months (postadjuvant treatment). There were 3 types of stress measured: number of stressful life events (K. A. Matthews et al., 1997), cancer-related traumatic stress symptoms (M. J. Horowitz, N. Wilner, & W. Alvarez, 1979), and perceived global stress (S. Cohen, T. Kamarck, & R. Mermelstein, 1983). Using hierarchical multiple regressions, the authors found that stress predicted both psychological and physical QoL (J. E. Ware, K. K. Snow, & M. Kosinski, 2000) at the follow-ups (all ps     

Mixed messages: Implications of social conflict and social support within close relationships for adjustment to a stressful life event.

The authors examined the impact of women's perceptions of negative (conflict) and positive (support) exchanges with their mothers, partners, and friends before having an abortion on negative (distress) and positive (well-being) indexes of adjustment after the abortion. Preabortion conflict and support from the partner predicted postabortion adjustment in the same affective domain: Conflict uniquely predicted distress, whereas support uniquely predicted well-being. Within-source interactions were observed between support and conflict from mothers and friends. Women who perceived high support from their mothers or friends were more distressed if they also perceived them as sources of high conflict than if they perceived them as sources of low conflict. Among women who perceived their mothers or friends as nonsupportive, no relationship was observed between conflict and distress. Cross-source buffering was not observed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Anger toward God: Social-cognitive predictors, prevalence, and links with adjustment to bereavement and cancer.

Many people see themselves as being in a relationship with God and see this bond as comforting. Yet, perceived relationships with God also carry the potential for experiencing anger toward God, as shown here in studies with the U.S. population (Study 1), undergraduates (Studies 2 and 3), bereaved individuals (Study 4), and cancer survivors (Study 5). These studies addressed 3 fundamental issues regarding anger toward God: perceptions and attributions that predict anger toward God, its prevalence, and its associations with adjustment. Social-cognitive predictors of anger toward God paralleled predictors of interpersonal anger and included holding God responsible for severe harm, attributions of cruelty, difficulty finding meaning, and seeing oneself as a victim. Anger toward God was frequently reported in response to negative events, although positive feelings predominated. Anger and positive feelings toward God showed moderate negative associations. Religiosity and age correlated negatively with anger toward God. Reports of anger toward God were slightly lower among Protestants and African Americans in comparison with other groups (Study 1). Some atheists and agnostics reported anger involving God, particularly on measures emphasizing past experiences (Study 2) and images of a hypothetical God (Study 3). Anger toward God was associated with poorer adjustment to bereavement (Study 4) and cancer (Study 5), particularly when anger remained unresolved over a 1-year period (Study 5). Taken together, these studies suggest that anger toward God is an important dimension of religious and spiritual experience, one that is measurable, widespread, and related to adjustment across various contexts and populations. (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)     

My children and me: Midlife evaluations of grown children and of self.

215 midlife parents (mean age 53.7 yrs) were interviewed about how their adult children (mean age 27.6 yrs) had "turned out." These assessments were then related to parents' views of themselves. Perceived accomplishments and adjustment of children were expected to be positively linked with parents' well-being (e.g., self-acceptance, environmental mastery, purpose in life), and social comparisons were hypothesized to contribute to the link between parents' assessments of children and their own well-being. Multiple regression analyses revealed that children's perceived adjustment significantly predicted 6 of 7 well-being outcomes for mothers and fathers. Children's attainment was less strongly linked with parental outcomes. Personal comparisons were significant negative predictors: Parents who saw their children as better adjusted than themselves had lower well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Presence of activated B-1 cells in chronic inflamed gingival tissue

The oncology nurse's role in breast cancer management is enhanced by knowledge of the patient's perceptions of risks. This case study elucidates the process by which perceived risks of breast cancer are embedded in sequences of biographic experiences including childhood sexual abuse, childhood injuries, and an abusive marriage. The case study shows that risk perceptions and subsequent delayed breast cancer detection is related to (a) a belief that breast cancer results from "bad luck, or fate"; (b) lack of cancer-related symptoms; (c) belief that a higher power determines ill health; (d) reluctance to turn to others for help while in an abusive marriage; (e) family history of cancer invulnerability since generations of family members died of diabetes, heart disease, and pregnancy-related illnesses; and (f) fear of gynecologic exams resulting from childhood sexual abuse. Furthermore, nonapplicability of traditional breast cancer risk factors such as heredity, age older than 30 years at first full-term pregnancy, early menarche, and late menopause prohibit an accurate assessment of self-risk. This case study suggests that breast cancer risk perception often differs from that of biomedical factors, and that an understanding of risk judgments is essential for appropriate therapeutic responses.     

Psychological adjustment in breast cancer: Processes of emotional distress.

The process of psychological adjustment to breast cancer was examined at diagnosis and at 3- and 6-month follow-ups in a sample of 80 women with Stage I–Stage IV breast cancer. At diagnosis, symptoms of anxiety/depression were predicted by low dispositional optimism, and this path was partially mediated by use of emotion-focused disengagement coping. Younger age also was predictive of anxiety/depression symptoms at time of diagnosis and this relationship was fully mediated by magnitude of intrusive thoughts. At 3 months, changes in anxiety/depression symptoms were predicted only by intrusive thoughts. At 6 months, low dispositional optimism reemerged as a significant predictor of changes in anxiety/depression and again was partially mediated by the use of emotion-focused disengagement coping. Independent effects for problem-focused engagement and disengagement and emotion-focused engagement coping were also found at 6 months. Implications of these data for psychosocial interventions with breast cancer patients are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Actual change and inaccurate recall contribute to posttraumatic growth following radiotherapy.

People with cancer often report that they experience personal growth as a result of the disease, but such reports have unclear validity. Some suggest such growth results from Rogers's (1951) hypothesized organismic valuing process (OVP), an innate tendency for people to gravitate toward well-being; others suggest this growth may be a positive illusion resulting from temporal self-comparisons. To test these conceptualizations, the authors examined 83 individuals with Stages 0-III breast or prostate cancer. Patients completed measures of positive attributes and personal life goals before radiotherapy (Time 1) and after radiotherapy (Time 2). At Time 2, participants also attempted to recreate their Time 1 responses and completed a posttraumatic growth (PTG) measure. PTG was significantly related with actual increases (but not perceived increases) in the relative importance of intrinsic goals versus extrinsic goals and with perceived increases (but not actual increases) in positive attributes. These measures were unrelated to one another and thus explained unique variance in PTG. Data suggest that both actual change processes related to the OVP and biases in autobiographic recall may independently contribute to PTG reports. (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)     

Finding meaning, perceiving growth, and acceptance of tinnitus.

Objectives: The authors test hypotheses derived from current models of growth following adversity in a sample of people with tinnitus. These models assume a process whereby adversity or trauma threatens major assumptions, which, in turn, promotes a search for meaning in the adversity and subsequently growth. Method: Data from a sample of 315 people with tinnitus who completed an online survey were used to assess the relations of reports of negative changes to asking "Why me?" and answering the Why me? question with reports of growth, acceptance, and well-being. Results: indicate that reports of negative changes in goals and philosophy of life predict a search for meaning and that finding meaning is associated with perceived growth. Those who report never searching for meaning are less likely to report growth but report better adjustment and acceptance of their tinnitus than those who have searched for meaning. Discussion: The data are consistent with models of growth that give a central role to meaning-making processes, but they also suggest that a significant minority of people with tinnitus do not report searching for meaning or perceiving growth--yet appear to be coping well. Acceptance of tinnitus is identified as a key construct for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cancer and the threat of death: The cognitive dynamics of death-thought suppression and its impact on behavioral health intentions.

Five studies examined the cognitive association between thoughts of cancer and thoughts of death and their implication for screening intentions. Study 1 found that explicit contemplation of cancer did not increase death-thought accessibility. In support of the hypothesis that this reflects suppression of death-related thoughts, Study 2 found that individuals who thought about cancer exhibited elevated death-thought accessibility under high cognitive load, and Study 3 demonstrated that subliminal primes of the word cancer led to increased death-thought accessibility. Study 4 revealed lower levels of death-thought accessibility when perceived vulnerability to cancer was high, once again suggesting suppression of death-related thoughts in response to conscious threats associated with cancer. Study 5 extended the analysis by finding that after cancer salience, high cognitive load, which presumably disrupts suppression of the association between cancer and death, decreased cancer-related self-exam intentions. Theoretical and practical implications for understanding terror management, priming and suppression, and responses to cancer are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)