Cognitive and social processes predicting partner psychological adaptation to early stage breast cancer

Introduction. The diagnosis and subsequent treatment for early stage breast cancer is stressful for partners. Little is known about the role of cognitive and social processes predicting the longitudinal course of partners' psychosocial adaptation. This study evaluated the role of cognitive and social processing in partner psychological adaptation to early stage breast cancer, evaluating both main and moderator effect models. Moderating effects for meaning making, acceptance, and positive reappraisal on the predictive association of searching for meaning, emotional processing, and emotional expression on partner psychological distress were examined. Materials and methods. Partners of women diagnosed with early stage breast cancer were evaluated shortly after the ill partner's diagnosis (N=253), 9 (N=167), and 18 months (N=149) later. Partners completed measures of emotional expression, emotional processing, acceptance, meaning making, and general and cancer‐specific distress at all time points. Results. Lower satisfaction with partner support predicted greater global distress, and greater use of positive reappraisal was associated with greater distress. The predicted moderator effects for found meaning on the associations between the search for meaning and cancer‐specific distress were found and similar moderating effects for positive reappraisal on the associations between emotional expression and global distress and for acceptance on the association between emotional processing and cancer‐specific distress were found. Conclusions. Results indicate several cognitive–social processes directly predict partner distress. However, moderator effect models in which the effects of partners' processing depends upon whether these efforts result in changes in perceptions of the cancer experience may add to the understanding of partners' adaptation to cancer.     

Cancer-related loneliness mediates the relationships between social constraints and symptoms among cancer patients

Cancer patients have high rates of persistent and disabling symptoms. Evidence suggests that social constraints (e.g., avoidance and criticism) negatively impact symptoms, but pathways linking these variables have yet to be identified. This study examined whether cancer-related loneliness (i.e., feeling socially disconnected related to having cancer) mediated the relationships between social constraints and symptoms (i.e., pain interference, fatigue, sleep disturbance, and cognitive complaints) in patients with various cancers (N = 182). Patients (51% female, mean age = 59) were recruited from the Indiana Cancer Registry and completed questionnaires assessing social constraints, cancer-related loneliness, and symptoms. Structural equation modeling was used to evaluate the hypothesized relationships among variables. The model demonstrated good fit. Consistent with our hypothesis, cancer-related loneliness mediated the relationships between social constraints and each symptom. Findings suggest that addressing cancer-related loneliness in symptom management interventions may mitigate the negative impact of social constraints on outcomes.     

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.     

Psychological Adjustment Following Diagnosis and Treatment of Cancer: An Examination of the Moderating Role of Positive and Negative Emotional Expressivity

In support of cognitive processing models, emotional expression appears to reduce associations between intrusions and psychological distress. Past research has focused primarily on the role of the expression of negative emotion, or emotion in general, in cognitive processing and adjustment. In the present study, we examined the role of both positive and negative emotional expressivity on relations between intrusions and both distress and avoidance among 93 individuals diagnosed with and treated for cancer. We hypothesized stronger negative associations between intrusive thoughts and both distress and avoidance for those individuals lower in positive or negative expressivity. Results generally supported hypotheses with regard to relations of intrusions and distress in association with positive expressivity. Negative expressivity, however, moderated relations between intrusions and distress, but not intrusions and avoidance. These findings underscore the importance of examining the impact of individual differences in negative, as well as positive, emotional expression on cognitive processing and psychological adjustment.     

Intrusive thoughts and psychological distress among cancer patients: the role of spouse avoidance and criticism.

This study examined whether perceived spouse criticism and avoidance impacted cognitive processing in 129 cancer patients. It was hypothesized that intrusive thoughts would be associated with an increase in psychological distress among patients who felt their spouses were critical or avoiding them and that intrusive thoughts would not be positively associated with distress among patients who did not feel their spouses were critical or avoidant. The impact of spouse criticism was predicted to be stronger than the impact of spouse avoidance. A moderating effect for spouse criticism on the association between early intrusive thoughts and later distress was present. Spouse avoidance did not have a significant moderating effect on the relation between intrusive thoughts and later distress. Results suggest spouse criticism and avoidance may have differential effects on the cognitive processing of cancer.     

Peer victimization, cue interpretation, and internalizing symptoms: preliminary concurrent and longitudinal findings for children and adolescents.

This study examined hostile intent and causal, critical self-referent attributions for ambiguous peer cues to examine the hypothesis that these latter interpretations would be uniquely associated with symptoms of depression, social anxiety, and loneliness. Critical self-referent attributions were assessed in 116 kindergarteners (Study 1) and 159 adolescents (Study 2) using a hypothetical vignette procedure, replicating past work on social information processing. In both samples, critical self-referent attributions were concurrently associated with depressive symptoms as reported by teacher (Study 1), peer, and self-report (Study 2). Critical self-referent attributions also were concurrently associated with loneliness and with actual peer experiences, including peer rejection in both studies. Results from both studies support a cognitive vulnerability-stress model, suggesting that the tendency to derive critical self-referent attributions from ambiguous peer experiences is most closely associated with depressive symptoms when accompanied by high levels of peer victimization. Longitudinal findings (Study 2) offers preliminary evidence for this cognitive vulnerability-stress model as a predictor of adolescents' depressive symptoms over a 17-month interval.     

Implicit loneliness,emotion regulation,and depressive symptoms in breast cancer survivors

Among individuals coping with cancer, emotional approach coping—expressing and processing emotions following negative events—has been identified as a potentially adaptive form of emotion regulation. However, its mental health benefits may depend on social-cognitive factors and on how it is implemented. This study examined loneliness as a determinant of emotion regulation associations with depressive symptoms in women with breast cancer. Loneliness was examined as an implicit social-cognitive phenomenon (i.e., automatic views of oneself as lonely), and emotional expression and processing were examined as both explicit and implicit processes. Approximately 11 months after diagnosis, 390 women completed explicit measures of coping through cancer-related emotional expression and processing; an implicit measure of expression and processing (an essay-writing task submitted to linguistic analysis); and an implicit association test measuring loneliness. Depressive symptoms were assessed 3 months later. Regardless of implicit loneliness, self-reported emotional expression (but not emotional processing) predicted fewer depressive symptoms, whereas implicit expression of negative emotion during essay-writing predicted more symptoms. Only among women high in implicit loneliness, less positive emotional expression and more causal processing during the writing task predicted more depressive symptoms. Results suggest that explicit and implicit breast cancer-related emotion regulation have distinct relations with depressive symptoms, and implicit loneliness moderates effects of implicit emotional approach. Findings support implicit processes as influential mechanisms of emotion regulation and suggest targets for intervention among breast cancer survivors.     

Social barriers to emotional expression and their relations to distress in male and female cancer patients

Objective: Emotional expression is an important means of coping with stressful experiences such as cancer. Social barriers to expression may have adverse effects. Research has suggested that men are less likely to express their emotions and have different patterns of social support compared to women. We examined whether male cancer patients have a lower tendency to express emotions, are less likely to perceive social barriers to expression, and are differentially affected by social barriers from different support sources as compared to women. Design: Questionnaires were administered to 41 women and 41 men using a cross‐sectional study design. Method: Patients diagnosed with gynaecological or prostate cancer within the past 5 years completed questionnaires on moods, intrusive thoughts, social constraints and emotional expressivity. Results: There was a trend towards greater emotional expressivity in women as compared to men, but no significant gender differences in perceptions of social constraints from spouse/partner or others. Multiple regression analyses revealed that men experienced significantly greater distress in association with social constraints from their spouse/partner than did women. Conclusion: Men may be more vulnerable to social barriers to expression than previously assumed. Gender differences in emotional expressivity may be less important than the social context in which expression takes place.     

The Relationship Between Threat Appraisal and Social Constraints in Cancer Survivors and Their Spouses

Social constraints stem from unsupportive social environments and are associated with reluctance to discuss stressor-related thoughts and feelings. Support deterioration and erosion models provide a framework for explaining how a cancer patient's threat appraisal contributes to a spouse's inadvertent constraint on the patient's emotional expression. Also, based on social comparison theory and the convoy model, a discrepancy in threat appraisal between patient and spouse may create social constraints. Contrary to social cognitive processing theories, we hypothesized that threat appraisals may be an antecedent of social constraints, rather than a consequence. Cancer patients (n=75) and their spouses (n=75) completed questionnaires assessing cancer-related threat appraisals and perceived spousal social constraints at two time points. Cross-lagged panel design results suggested that patient appraisal precedes and predicts patients’ perception of social constraints. However, patient and spouse appraisals did not significantly interact in predicting spousal constraints. Limitations and implications are discussed.     

Predictors of social support and psychological distress in women with breast cancer

This investigation sought to understand previous well-cited and worrisome findings that women treated for breast cancer with breast-conserving surgery compared to mastectomy experience less social support and more mood disturbance, and that social support from significant others erodes over time. Ninety-three women with breast cancer and a subset of their partners completed assessments at the time of surgical treatment and at 3 and 13 months post-treatment. Contrary to the previous findings, type of surgical treatment was not related to perceptions of social support or psychological functioning. Perceptions of social support and psychological distress decreased over time, and the discrepancy between recipients' and providers' judgments of available support increased over time. Low levels of physical functioning led to relative increases in social support, whereas high levels of psychological distress led to relative decreases in social support. Social support as rated by patients (but not their partners) was a significant predictor of changes in psychological distress.     

An effectiveness study of a CBT group program for women with breast cancer

Cognitive Behaviour Stress Management for women with breast cancer has demonstrable empirical efficacy, however its effectiveness in the applied clinical setting has not been examined to date in an Australian setting. A 10‐week group program was offered to five women with early stage breast cancer. Clinical changes in distress, coping, and social support from pre‐test, to post‐test and 1‐month follow‐up are reported. Overall, the group yielded strong favourable effect sizes indicating clinical improvement over time in PTSD symptoms and social support, but strong unfavourable effect sizes in cognitive avoidance. In terms of clinical cut‐offs, all women met criteria for PTSD at baseline, with two women recovering at follow‐up. The two participants with highest baseline distress experienced large improvements in depression, anxiety and PTSD at post‐treatment, but rebounded to baseline at follow‐up. Women qualitatively reported the major benefits of the program to be acquiring skills in relaxation and cognitive restructuring, and obtaining social support. This case study provides preliminary support that a CBSM program can improve PTSD and social support, however it raises concerns regarding the deteriorations observed in cognitive avoidance. Ways of addressing cognitive avoidance and the maintenance of gains warrants further investigation.     

Psychological distress two years after diagnosis of breast cancer: frequency and prediction

The present prospective study aimed at (1) investigating the frequency of high levels of psychological distress in women with early-stage breast cancer almost two years after diagnosis and (2) identifying characteristics associated with long-term distress. One hundred and seventy women participated on two occasions. Two months after surgery, patients completed questionnaires measuring psychosocial variables (e.g., stressful life-events, health complaints, sleep problems, social support, subjective distress, personality factors), demographic and biomedical variables (e.g., TNM status, type of surgery). At the second measurement, subjective distress was assessed for a second time by means of the Impact of Events Scale (IES). Almost two years after diagnosis, 16% of the women reported a high level of psychological distress as measured by the Intrusion scale (IES). Best predictors of a high level of distress were: intrusive thoughts about the disease, trait-anxiety, health complaints and problems with sleeping. No significant association was found between previous life-events, social support or biomedical variables and levels of distress.     

Masculine norms about emotionality and social constraints in young and older adult men with cancer

Beliefs that men should restrict their display of emotions, or restrictive emotionality, might contribute to adjustment to cancer and this might be sensitive to social receptivity to disclosure. The present research examined relationships of restrictive emotionality, social constraints, and psychological distress in young adults with testicular cancer (N = 171; Study 1) and older men with prostate cancer (N = 66; Study 2). Study 1: positive associations were observed for social constraints and restrictive emotionality with depressive symptoms. Social constraints moderated the relationship, such that high restrictive emotionality was associated with higher depressive symptoms in those with high constraints. Study 2: only social constraints (and not restrictive emotionality) was positively associated with depressive symptoms and cancer-related intrusive thoughts. The social constraints × restrictive emotionality interaction approached significance with depressive symptoms, such with high social constraints low restrictive emotionality was associated with higher depressive symptoms compared to those with less constraints. No significant associations were found for intrusive thoughts in either study. Findings demonstrate unique relationships with psychological distress across the lifespan of men with cancer given perception of constraints and adherence to masculine norms about emotionality.     

Parent and family factors associated with child adjustment to pediatric cancer

OBJECTIVE: To identify factors that influence the association between parent and child distress among families of children with cancer and comparison peers. METHODS: Parent and child distress, social support, and family environment were assessed among families of 95 children with cancer (94 mothers, 67 fathers) and 98 comparison peers (97 mothers, 77 fathers). RESULTS: Significant associations were found between parent and child distress. For models examining the impact of fathers' distress on children, several moderators were identified (i.e., family environment, child age and gender, a cancer diagnosis, and treatment severity). Family environment also partially mediated father and child distress. CONCLUSIONS: Children whose parents were distressed were more likely to be distressed themselves. Subgroups of children were particularly vulnerable, indicating a need to identify further mechanisms of risk and resilience and to develop family-based interventions. Support was found for including fathers as independent sources of information in pediatric psychology research and clinical practice.     

高师生害羞与孤独感的关系:社会支持的中介作用

目的探讨社会支持在高师生害羞与孤独感之间的中介作用。方法采用害羞量表、领悟社会支持量表及感情与社会孤独量表对525名高师生进行调查。结果①相关分析表明,孤独感与害羞有显著正相关(r=0.414,P<0.01),与社会支持有显著负相关(r=-0.558,P<0.01);害羞与社会支持有显著负相关(r=-0.29,P<0.01);②路径分析表明,害羞不仅可以直接预测孤独感,还可以通过社会支持间接预测孤独感。结构模型拟合指数GF I=0.99,CF I=1.00,NF I=0.99,拟合良好。结论社会支持是害羞与孤独感关系的中介变量。     

Self-Blame and Distress Among Women with Newly Diagnosed Breast Cancer

This study examined relations between behavioral and characterological self-blame attributions for breast cancer and psychological distress in the year following a diagnosis. One hundred fifteen women with newly diagnosed breast cancer participated. First, we predicted that both forms of self-blame would be associated with distress shortly after diagnosis (i.e., at 4 months). Second, we predicted that only characterological self-blame would be related to distress at 7 and 12 months post-diagnosis because behavioral self-blame would enhance perceptions of control, thereby protecting against distress. Results supported the first hypothesis; both forms of self-blame were related to symptoms of anxiety and depression at 4 months post-diagnosis. Findings did not support the second hypothesis because both forms of self-blame continued to be related to distress at 7 and 12 months post-diagnosis. Furthermore, perceptions of control did not mediate the self-blame/distress relation. Implications for social cognitive processes in adaptation to breast cancer are discussed.     

Girls' and mothers' social anxiety, social skills, and loneliness: associations after accounting for depressive symptoms.

This study examined, in 102 mother-daughter dyads, whether (a) girls' social skills and loneliness are related to girls' social anxiety, after adjusting for girls' depressive symptoms, and (b) mothers' social functioning (social anxiety, social skills, and loneliness) is related to girls' social anxiety, after accounting for girls' social functioning (social skills and loneliness) and mothers' and girls' depressive symptoms. After accounting for girls' depression, girls' loneliness (and not social skills) was related to girls' self-reported social anxiety and girls' social skills (and not loneliness) were related to mothers' reports of girls' social anxiety. Mothers' social functioning accounted for significant variance in girls' social anxiety, beyond that accounted for by girls' social functioning and mothers' and girls' depression. Mothers' loneliness and fear of negative evaluation showed significant relations to girls' social anxiety when variance attributable to other variables was partialed out, whereas mothers' social skills and social avoidance and distress did not. Directions for future research on social anxiety are highlighted.     

Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam

ObjectivesThe aim of this study was to examine the association between physical frailty and social functioning among older adults, cross-sectionally and prospectively over 3 years.Study designThe study sample consisted of 1115 older adults aged 65 and over from two waves of the Longitudinal Aging Study Amsterdam, a population based study.Main outcome measuresFrailty was measured at T1 (2005/2006) using the criteria of the frailty phenotype, which includes weight loss, weak grip strength, exhaustion, slow gait speed and low physical activity. Social functioning was assessed at T1 and T2 (2008/2009) and included social network size, instrumental support, emotional support, and loneliness.ResultsCross-sectional linear regression analyses adjusted for covariates (age, sex, educational level and number of chronic diseases) showed that pre-frail and frail older adults had a smaller network size and higher levels of loneliness compared to their non-frail peers. Longitudinal linear regression analyses adjusted for covariates and baseline social functioning showed that frailty was associated with an increase in loneliness over 3 years. However, the network size and levels of social support of frail older adults did not further decline over time.ConclusionsFrailty is associated with poor social functioning, and with an increase in loneliness over time. The social vulnerability of physical frail older adults should be taken into account in the care provision for frail older adults.     

警察的孤独感状况及其相关因素分析

目的：探讨警察的孤独感状况及其与心理健康、应对方式、社会支持的相关关系。方法：采用UCLA孤独量表，SCL-90症状自评量表，TCSQ特质应对方式问卷和PsSS领悟社会支持量表。对某市区公安分局884名公安干警进行调查。结果：派出所警察的孤独感明显高于机关干警。50—59岁组警察的孤独感明显低于其他年龄段。警察的孤独感与警种、积极应对、社会支持显著负相关，与消极应对及SCL-90得分显著正相关。年龄、婚姻状况、应对方式、社会支持以及SCL-90总分是影响警察孤独感的显著因素。结论：警察的孤独感程度较高。50岁以下的派出所民警，尤其是婚姻不稳定者是孤独敏感群体。警察的孤独感与应对方式、社会支持及心理健康水平相互影响。     

Self-Report and Linguistic Indicators of Emotional Expression in Narratives as Predictors of Adjustment to Cancer

Emotional expression and cognitive efforts to adapt to cancer have been linked to better psychological adjustment. However, little is known about the relationship between linguistic indicators of emotional and cognitive coping efforts and corresponding self-report measures of related constructs. In this study, we sought to evaluate the interrelationships between self-reports of emotional suppression and linguistic indicators of emotional and cognitive coping efforts in those living with cancer. Seventy-one individuals attending a community cancer support group completed measures of emotional suppression and mood disturbance and provided a written narrative describing their cancer experience. Self-reports of emotional suppression were associated with more rather than less distress. Although linguistic indicators of both emotional expression and cognitive processing were generally uncorrelated with self-report measures of emotional suppression and mood disturbance, a significant interaction was observed between emotional suppression and use of cognitive words on mood disturbance. Among those using higher levels of emotional suppression, increasing use of cognitive words was associated with greater levels of mood disturbance. These findings have implications for a) the therapeutic use of emotion in psychosocial interventions and b) the use of computer-assisted technologies to conduct content analysis.