Optimism, perceived risk of breast cancer, and cancer worry among a community-based sample of women.

Optimism is frequently inversely associated with distress; however, less is known about the mechanisms underlying this relationship. Optimism can be defined as having a generalized positive expectancy about the future. The authors hypothesized that a specific expectancy might mediate the relationship between optimism and distress. That model was tested using perceived risk of breast cancer as a specific measure of expectancy and cancer worry as a measure of distress in a community-based sample of 1,366 women. It was hypothesized that optimism would be inversely associated with cancer worry and that perceived risk of breast cancer would mediate the relationship between optimism and cancer worry. Multiple regression analyses revealed that perceived risk partially mediated the relationship between optimism and cancer worry.     

Does the Broaden-and-Build Theory Explain Reduction in Social Disruption After a Brief Relaxation Intervention for Women With Breast Cancer Undergoing Treatment?

Women with breast cancer experience social disruption during and after treatment. Brief cognitive-behavioral (CBT) and relaxation (RT) interventions may improve social disruption by increasing positive affect. Using the Broaden-and-Build Theory as a framework, this study examined whether short-term CBT- and RT-related increases in positive affect mediate long-term reductions in social disruption in women with breast cancer undergoing treatment (N = 183). This secondary analysis used latent change score and growth models to test 6- and 12-month intervention effects on positive affect and social disruption, respectively; a parallel-process model assessed mediation. RT demonstrated larger reductions in social disruption across 12 months compared to CBT and a health education control. Six-month latent change in positive affect was significant but not driven by condition. There was a significant direct effect linking the latent slopes of positive affect and social disruption but meditation was not observed. These preliminary findings hint at the value of promoting positive affect and inform the development of brief behavioral interventions that aim to augment social functioning among women surviving breast cancer.     

Better Days – A randomized controlled trial of an internet-based positive psychology intervention

The internet seems promising for delivering interventions to enhance well-being in a normal population. The aim of this study was to test the effects of an internet-based positive psychology intervention targeting gratitude, pleasant activities, strengths, mastery, acts of kindness, optimism, flow, attributions, and mindfulness. One-hundred and twelve participants were randomized to the intervention and 94 to the control group, and data were collected at baseline, one, two, and six months after intervention onset. The balance of positive to negative affect increased over time among participants in the intervention group (unstandardized beta coefficient [B]?=?0.07, p?<?0.01), as compared to the controls (B?=?0.02, p?=?010). The intervention worked equally well regardless of participants’ gender, age, or education. However, optimism did not mediate the effect of the intervention on affect balance. In conclusion, the intervention had a small, but significant effect on affect balance among healthy adults.     

The Role of Optimism,Social Constraints,Coping, and Cognitive Processing in Psychosocial Adjustment Among Breast Cancer Survivors

The social-cognitive processing model suggests that a socially constrained environment may impede adjustment to a chronic illness. The present study primarily investigated the mediating psychological pathways through which social constraints on cancer-related disclosure, low optimism, disengagement-oriented coping, and brooding could be associated with low levels of psychosocial adjustment. One hundred twenty-five female breast cancer survivors participated in a cross-sectional study. Path analysis was used to examine the proposed model. Low optimism, increased social constraints, and higher levels of brooding appeared to be risk factors for poor psychosocial adjustment to breast cancer. Disengagement-oriented coping and brooding partially mediated the relationship between social constraints and adjustment. Brooding totally mediated the relationship between disengagement-oriented coping and adjustment. The current findings provide support for the value of the social-cognitive processing model among breast cancer survivors. The mapping of psychological pathways of adjustment to breast cancer may have useful clinical implications for better adjustment outcomes.     

Enhanced counselling for women undergoing BRCA1/2 testing: Impact on knowledge and psychological distress–results from a randomised clinical trial

This randomised controlled trial evaluated the impact of an enhanced counselling (EC) intervention on knowledge about the heritability of breast and ovarian cancer and distress, as a function of BRCA test result, among high-risk women. Before deciding about whether or not to undergo genetic testing, participants were randomly assigned to the EC intervention (N = 69), designed to promote cognitive and affective processing of cancer risk information (following the standard individualised counselling session), or to the control condition (N = 65), which involved standard individualised counselling followed by a general health information session to control for time and attention. Women in the EC group exhibited greater knowledge than women in the control group, 1 week after the intervention. Further, at the affective level, the intervention was found to be the most beneficial for women testing positive: specifically 1 week after test result disclosure, women in the intervention group who tested positive experienced lower levels of distress than women in the control group who tested positive. The findings suggest that the design of counselling aids should include a component that explicitly activates the individual's cognitive–affective processing system.     

Distress, personality, and mammography utilization among women with a family history of breast cancer.

The authors examined the impact of psychological distress and the personality construct of conscientiousness (as measured by the Neuroticism, Extraversion, and Openness-Five Factor Inventory) on mammography utilization among women who were at increased risk for breast cancer. Participants were 200 women who had at least 1 first degree relative with breast cancer. Overall, 80% of the participants had obtained a mammogram in the previous year. Analyses controlling for potential confounders (perceived risk, decisional balance, and physician recommendation for mammography), revealed that distress was negatively associated with mammography utilization among participants who were low in conscientiousness. Distress was not significantly related to mammography utilization among highly conscientious women. The results are discussed in terms of their implications regarding interventions designed to increase mammography utilization in this population.     

Evaluation of a peer support program for women with breast cancer—lessons for practitioners

The present study aimed to describe how a volunteer peer support service assists women with breast cancer, and provides guidelines for practitioners in the development and implementation of such programmes. A two‐phase evaluation of a breast cancer peer support program was undertaken to describe important attributes of the peer support intervention, the impact of the volunteer visit on women's self‐reports of anxiety, and key indicators of a successful volunteer visit. Phase 1 included focus groups with 57 women previously treated for breast cancer. Phase 2 included a survey of 245 women also treated previously for breast cancer and visited by a Breast Cancer Support Volunteer. The key aspect of the peer support process was the bond of common experience leading to a decrease in social isolation, an increase in optimism about the future and reassurance about personal reactions and femininity. It is recommended that peer support programmes should aim to time support visits to coincide with the time when patient support needs are highest, that volunteers need to be recruited from a range of backgrounds and matched to patients most similar to them in way of life, and that peer support services should be embedded in a broad network of community support services. Copyright © 1999 John Wiley & Sons, Ltd.     

Perceived stress management skill mediates the relationship between optimism and positive mood following radical prostatectomy.

This study evaluated relations among optimism, perceived stress management skills (PSMS),and positive mood in 46 men who had surgical treatment for localized prostate cancer. The authors found that optimism, PSMS, and positive mood scores were positively correlated. Positive mood was unrelated to demographic and disease-related control variables. In a hierarchical regression model controlling for PSMS, the relationship between optimism and positive mood became nonsignificant, whereas PSMS remained a correlate of positive mood. Results suggest that the relationship between optimism and positive mood may be mediated by belief in being able to use stress management techniques effectively.     

Development of an Interactive Decision Aid for Female BRCA1/BRCA2 Carriers

Shared decision making between patients and providers is becoming increasingly common, particularly when there is no clear preferred course of action. As a result, decision aids are being adopted with growing frequency and have been applied to many medical decision-making issues. One such issue where there is uncertainty is breast cancer risk management among BRCA1/BRCA2 carriers. We present the development of a CD-ROM decision aid to facilitate risk management decision making in this population. Our decision aid was developed with the intention of providing it through a randomized clinical trial. The CD-ROM is a multimedia, interactive intervention which provides information about breast cancer, risks associated with BRCA1 and BRCA2 mutations, risk management options for hereditary breast cancer, and a breast cancer risk management decision aid. The goal of this CD-ROM, offered as an adjunctive intervention, is to reduce decisional conflict and psychological distress and improve comprehension of risk information, decisional satisfaction, medical adherence, and quality of life for this population of women at increased risk for breast cancer.     

Unmitigated Communion and Adjustment to Breast Cancer: Associations and Explanations1

The goal of this study was to examine the implications of unmitigated communion (a focus on others to the exclusion of the self) for adjustment to breast cancer and to explain any observed relations. Cognitive adaptation theory was the primary explanatory framework adopted. Unmitigated communion was cross‐sectionally associated with poor mental and physical functioning among women newly diagnosed with breast cancer. Prospectively, unmitigated communion predicted a decline in a couple of indicators of mental and physical functioning over 3 months. Unmitigated communion was inversely associated with indicators of cognitive adaptation: low self‐esteem, poor body image, less optimism, and greater reliance on external control. Unmitigated communion also was associated with more negative interactions with network members and a decline in support over time. The decline in body image over time had the greatest potential to explain links of unmitigated communion to poor adjustment to disease.     

Psychological adjustment among African American breast cancer patients: one-year follow-up results of a randomized psychoeducational group intervention.

The effectiveness of support group interventions for cancer patients has been established among White patients but has been virtually unstudied among minority patients. The current study represents the 1st randomized support group intervention targeted to African American women with breast cancer. Participants (N = 73) with nonmetastatic breast cancer were randomly assigned to an 8-week group intervention or an assessment-only control condition At 12 months, the intervention resulted in improved mood as well as improved general and cancer-specific psychological functioning among women with greater baseline distress or lower income. Subsequent research is needed to address effective methods of enrolling and following women with fewer psychosocial and financial resources, as they were the most likely to benefit from this particular intervention.     

Can psychological interventions increase optimism? A meta-analysis

Greater optimism is related to better mental and physical health. A number of studies have investigated interventions intended to increase optimism. The aim of this meta-analysis was to consolidate effect sizes found in randomized controlled intervention studies of optimism training and to identify factors that may influence the effect of interventions. Twenty-nine studies, with a total of 3319 participants, met criteria for inclusion in the analysis. A significant meta-analytic effect size, g = .41, indicated that, across studies, interventions increased optimism. Moderator analyses showed that studies had significantly higher effect sizes if they used the Best Possible Self intervention, provided the intervention in person, used an active control, used separate positive and negative expectancy measures rather than a version of the LOT-R, had a final assessment within one day of the end of the intervention, and used completer analyses rather than intention-to-treat analyses. The results indicate that psychological interventions can increase optimism and that various factors may influence effect size.     

乳腺癌患者“创伤后成长”的研究进展

近年来,乳腺癌的发病率不断上升,乳腺癌已逐渐成为危害女性健康的首位恶性肿瘤。手术给患者的身心带来很大伤害,但研究者发现,在与乳腺癌这一疾病做斗争的过程中患者会产生一种正向的心理变化,这就是积极心理学领域研究的创伤后成长。本文从创伤后成长内涵、国内外研究现状、测量工具、影响因素、干预方法等几方面对乳腺癌创伤后成长研究现状进行文献综述,为乳腺癌患者心理护理提供依据。     

Psychological and physical adjustment to breast cancer over 4 years: identifying distinct trajectories of change.

The goal of this study was to identify distinct trajectories of adjustment to breast cancer over 4 years as well as to distinguish among the different trajectories. The mental and physical functioning of 287 women with breast cancer who remained alive and disease free through 4 years of follow-up were examined. The majority of women showed slight and steady improvement in functioning with time, but subgroups of women were identified who showed marked improvement and marked deteriorations over time. Age successfully distinguished different trajectories of physical functioning. Indices of personal resources (i.e., self-image, optimism, perceived control) and social resources (i.e., social support) successfully distinguished different courses of mental and physical functioning.     

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.     

Applications cliniques en psychologie de la santé

The aim of the present article is to present recent and validated clinical applications in the field of health psychology, in particular regarding pain and chronic disease management. Techniques such as acceptance and engagement therapy, mindfulness meditation and positive emotions enhancement have proved to be successful. Mindfulness is an attribute of consciousness long believed to promote well-being. It is commonly defined as the state of being attentive to and aware of what is taking place in the present. By this way, mindfulness meditation learns to patients with chronic pain to reduce their pain sensation. Moreover, encourage patients to have positive emotions, such as gratitude, is efficient in long term well-being. Prospective studies reveal that optimism, coping strategies such as positive reframing and acceptance, and social support yield less distress for patients with chronic disease. Similarly, psychosocial interventions that foster optimistic appraisals, build coping strategies, and bolster social support are benefit for patients. Other methods such as Cognitive Behavioral Stress Management (CBSM), enable to significantly enhance quality of life, adaptation to illness and chronic disease patient compliance. This 10-week group CBSM intervention that includes anxiety reduction (relaxation training), cognitive restructuring, and coping skills training is tested among women with breast cancer and HIV patients. The intervention reduces reports of thought intrusion, anxiety and emotional distress. Furthermore, biofeedback through Heart Rate Variability appears to be an important component of the development of patient potential in terms of cognitive and emotional resources enabling better coping with stressful situations and hence maintaining optimal health conditions. Biofeedback treatment intervention on pain and quality of life is helpful in the rehabilitation of patients with chronic pain. Limits of these applications are discussed as well as future research directions.     

In God and CAM We Trust. Religious Faith and Use of Complementary and Alternative Medicine (CAM) in a Nationwide Cohort of Women Treated for Early Breast Cancer

Turning to faith in God or a higher spiritual power is a common way of coping with life-threatening disease such as cancer. Little, however, is known about religious faith among cancer patients in secular societies. The present study aimed at exploring the prevalence of religious faith among Danish breast cancer patients and at identifying whether socio-demographic, pre-cancer health status, clinical, and health behavior characteristics, including their use of complementary and alternative medicine (CAM), were associated with their degree of faith. Information on faith in God or a higher spiritual power and use of CAM was provided by a nationwide sample of 3,128 recurrence-free Danish women who had received surgery for early-stage breast cancer 15–16 months earlier. Socio-demographic, clinical, and health status variables were obtained from national longitudinal registries, and health behaviors had been assessed at 3–4 months post-surgery. Of the women, 47.3% reported a high degree of faith (unambiguous believers), 35.9% some degree of faith (ambiguous believers), while the remaining 16.8% were non-believers. Unambiguous believers were more likely than ambiguous believers to experience their faith as having a positive impact on their disease and their disease-related quality-of-life. When compared to non-believers, unambiguous believers were also older, had poorer physical function, and were more frequent users of CAM, and more inclined to believe that their use of CAM would have a beneficial influence on their cancer. Disease- and treatment-related variables were unrelated to faith. While overall religious faith appears equally prevalent among Danish and US breast cancer patients, the majority of Danish breast cancer patients experienced ambiguous faith, whereas the majority of US patients have been found to express unambiguous faith. Our results suggest that future studies may benefit from exploring the role of faith for health behaviors, adherence to conventional treatment, and impact upon quality of life.     

OLDER WOMEN AND THE PRACTICE OF BREAST SELF-EXAMINATION

Breast self-examination (BSE) for breast cancer is used by only a fraction of the women who might benefit from it, and some studies show that older women who are more at risk for breast cancer are less likely to use it. This article reports a community study of women ( n = 528) who were trained in BSE in women's group meetings, provided a behavioral management intervention, and followed for two years. The intervention consisted of monthly postcard cues for BSE and lottery ticket rewards whenever a BSE record was returned indicating a BSE had been done. During the second year, the intervention was withdrawn. Results show that although women over 50 are no more likely to report having done more BSEs than women under 50 prior to entering the study, they did tend to do more BSEs during the intervention year and were significantly more compliant during the follow-up year. A more detailed analysis by age decade showed the highest rates of compliance in both years were for women ages 60–69 and 70–87. An analysis of attitudinal, history, and sociodemographic factors indicated that the only consistent predictor of BSE practice other than age and the intervention was the woman's confidence in BSE.     

The Prevalence of Spirituality, Optimism, Depression, and Fatalism in a Bi-ethnic Stroke Population

To provide insight into the reduced post-stroke all-cause mortality among Mexican Americans, we explored ethnic differences in the pre-stroke prevalence of (1) spirituality, (2) optimism, (3) depression, and (4) fatalism in a Mexican American and non-Hispanic white stroke population. The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke surveillance study in Nueces County, Texas. Seven hundred ten stroke patients were queried. For fatalism, optimism, and depression scales, unadjusted ethnic comparisons were made using linear regression models. Regression models were also used to explore how age and gender modify the ethnic associations after adjustment for education. For the categorical spirituality variables, ethnic comparisons were made using Fisher's exact tests. Mexican Americans reported significantly more spirituality than non-Hispanic whites. Among women, age modified the ethnic associations with pre-stroke depression and fatalism but not optimism. Mexican American women had more optimism than non-Hispanic white women. With age, Mexican American women had less depression and fatalism, while non-Hispanic white women had more fatalism and similar depression. Among men, after adjustment for education and age, there was no ethnic association with fatalism, depression, and optimism. Spirituality requires further study as a potential mediator of increased survival following stroke among Mexican Americans. Among women, evaluation of the role of optimism, depression, and fatalism as they relate to ethnic differences in post-stroke mortality should be explored.     

The Impact of Breast Cancer Knowledge and Attitudes on Screening and Early Detection Among an Immigrant Iranian Population in Southern California

Few studies explored factors influencing breast cancer screening and early detection behaviors among immigrant Iranian women residing in the USA. Using a cross-sectional survey, a convenience sample of 319 Iranian American women was selected to investigate the impact of breast cancer knowledge and attitude on screening. A self-administered questionnaire assessed breast cancer screening knowledge, attitude, and mammography use (ever, previous year, and future intention). 79 % of the women in the study reported ever receiving at least one mammogram and 74 % received a mammogram in the past year. Personal attitude had an independent significant effect on: mammography use in the last year, ever use of mammography, and future intention to screen. Knowledge and morality-induced attitude influenced screening behavior but not significantly. Interventions targeting breast cancer screening among immigrant Iranian women in the USA should focus on enhancing personal attitudes in order to influence actual screening behavior.