Helpful processes in psychological therapy for patients with primary cancers: A qualitative interview study

Aims: The purpose of this study was to identify what patients with primary cancers found helpful in therapy. Method: In‐depth qualitative interviews were conducted with eight patients who had completed a course of psychological therapy within an NHS psychology service for cancer patients. Data were analysed using thematic analysis. Results: The participants identified a range of helpful processes in therapy: talking and expressing their feelings to someone outside of the family; forming a relationship with their therapist; normalisation through the therapists' expert knowledge; problem‐solving and CBT. Limitations: As with all qualitative studies, the small sample and size and dependence on participant recall limits generalisability of the findings. Implications: The findings of this study are consistent with a pluralistic perspective: that multiple therapeutic processes ‐ aligned to a range of different orientations ‐ can be of value to patients with primary cancers. This supports the provision of a range of therapeutic interventions and strategies for this patient group.     

Manifestations of anxiety and coping strategies in patients with metastatic lung cancer and their family caregivers: a qualitative study

Objective: Advanced non-small cell lung cancer (NSCLC) is common, deadly, and associated with impairing anxiety for patients and caregivers who often co-experience similar symptoms that can vary together over time. We aimed to discover themes as to how NSCLC patients and caregivers express and cope with anxiety.

Design: Semi-structured interviews of patient-caregiver dyads (N?=?21), coded using NVivo Software.

Main Outcome Measures: Open-ended questions on anxiety mutuality, giving or receiving care, communication, and the most difficult aspects of having or caring for someone with Stage IV NSCLC.

Results: Analyses revealed that patients and caregivers were linked psychologically, co-experiencing symptoms of distress or coping, rising and falling together. Shared patient and caregiver themes emerged of cognitive, behavioural and physiological manifestations of anxiety and coping mechanisms.

Conclusions: Patient and caregiver expressions of anxiety and coping methods mapped onto the cognitive-behavioural model, implying potential use of cognitive behavioural therapy (CBT) to address these issues. This expands understanding of symptoms and coping strategies in NSCLC, explores patient-caregiver interaction, and confirms the need for future clinical intervention. Future research should focus on development and dissemination of CBT-based dyadic interventions addressing anxiety in NSCLC patients and caregivers.     

Psychological support needs of patients with head and neck cancer and their caregivers: A qualitative study

Objective: The aim of this study was to explore the psychological support needs of patients with head and neck cancer (HNC) and their caregivers. The appropriate timing, length, format and content of sessions were also investigated.

Design: Eighty-three patients with HNC and 73 of their caregivers completed questionnaires at diagnosis. Follow-up questionnaires were mailed to patients six months later.

Main outcome measures: Free text-comments to open-ended questions in the questionnaires were analysed using an inductive thematic approach with coding and theme development directed by the content of responses. This was used to determine psychological support needs both at diagnosis and at six month follow-up.

Results: Patients described ‘just being there’, empathy, maintaining normality and practical support as helpful from family/friends. They desired information, honesty, positivity and empathy from clinical staff. Formal psychological support was desired by approximately 40% of patients and caregivers, particularly early after diagnosis and during treatment. Most participants desired face to face sessions, providing individualised information and coping strategies.

Conclusion: The results of this study suggest that psychological interventions for patients with HNC and their caregivers should be delivered early after diagnosis in face to face sessions, presenting honest and factual information about the disease and coping strategies.     

The burden of filial piety: A qualitative study on caregiving motivations amongst family caregivers of patients with cancer in Singapore

Objective. This study explores (1) the motivations and challenges facing family caregiving for cancer in Singapore and (2) suggests a possible framework to guide culturally sensitive future work on caregivers.

Design. Twenty caregivers of patients being treated for cancer at a public hospital in Singapore were interviewed. A semi-structured interview format and inductive thematic analysis were used to analyse the data. Caregivers were asked about their motivations for caregiving and the challenges they faced.

Results. Caregivers’ motivations grouped into three categories: personal value and fulfilment, giving care because of societal expectations such as filial piety, and practical need. Challenges were grouped into interpersonal challenges, disclosure and finding balance. Caregivers with different primary motivations varied in their responses to these challenges. More autonomous caregivers cited learning points and reprioritised more effectively than less autonomous caregivers, who reported more internal conflict and less control over their situation.

Conclusions. In Singapore and Asia, sociocultural values of family caregiving are not uniformly experienced as positive, and may be burdensome for caregivers who give care primarily for extrinsic motivations. As family caregiving needs increase, targeted psychosocial support for caregivers with less autonomous behavioural orientations may pre-empt caregiver burnout and burden.     

Explanatory models of mental illness: a qualitative study with Emirati future mental health practitioners

Cultural traits have an influence on the person's interpretation of mental illness, the expression of distress and help-seeking attitudes. UAE has a unique sociological context where Eastern and Western traditions coexist. Given that there is a scarcity of mental health studies and no study on the explanatory models (EM) of mental illness, it is important to examine the connections between Western biomedical approaches and traditional Emirati illness explanations and how those affect the Emirati EM. In order to explore the influence of those connections on Emirati future clinicians, the present study focuses on young Emirati psychology students in a Western-oriented university. In-depth interviews were performed regarding their EM. The results highlighted the influence of cultural traits on the EM formulation, the importance of family in the Emirati society and the impact of the UAE socio-economic and religious reality in forming the participants’ beliefs on mental illness.     

The difficulties assessing spiritual distress in palliative care patients: a qualitative study

This paper reports on a focus group study aimed at exploring the difficulties that palliative care healthcare professionals encounter while assessing the spiritual distress of their patients. Three focus groups were conducted in a hospice (n = 15). Participants were all healthcare professionals working in the hospice in-patient unit. Interviews were taped and later transcribed. The data was analysed through content analysis. Emergent themes included: lack of vocabulary around spiritual issues, personal issues surrounding death and dying, training issues, fear of being unable to resolve spiritual problems, time constraints and difficulty separating spiritual and religious needs. Participants provided a number of recommendations for improving care. This pilot study has generated useful data in relation to how spiritual care of patients might be improved. Despite the abundance of academic publications and policies on spirituality, this area is not integrated well into palliative care.     

The role of objective health indicators and neuroticism in perceived health and psychological well-being among patients with chronic heart failure

A total of 119 clinically stable patients with symptomatic congestive heart failure (34 females, 85 males) were recruited from an outpatient hospital practice to explore the role of objective health indicators and neuroticism in subjective health (physical limitations) and psychological well-being. Patients were grouped according to the New York Heart Association functional class criteria (NYHA: indicator of functional status) and proatrial natriuretic factor (proANF), a cardiac hormone that maintains normal fluid balance and vascular resistance. Scores on these two objective indicators of disease severity were generally unrelated to psychological measures, whereas neuroticism scores (EPQ-N) were significantly correlated with indicators of subjective health (perceived disease-related physical limitations) and psychological well-being (depression, general life-satisfaction). Significant interactions between proANF and neuroticism appear due to low physical limitation score among subjects with elevated level of proANF and low scores on neuroticism. High physical limitation was reported by subjects with high level of proANF as well as high scores on neuroticism. Moreover, a marginal significant interaction between NYHA and EPQ-N scores in relation to severity of depression was detected by analyses from two-way ANOVA. Gender differences were due to higher proANF scores in males than females, whereas females scored higher than males on EPQ-N, perceived physical limitation and depression. Results from path analyses supported an indirect effect of neuroticism via perceived physical limitation for males. Possible mechanisms involved in these relations are discussed.     

The link between emotional competence and well-being: a longitudinal study

What aspects of emotional competence help protect people from stress, anxiety, and depression, and help to promote positive affect? A total of 163 university students completed a two wave study that involved measuring emotional competence and emotional well-being at 1-year intervals. As expected, Time 1 measures of emotional competence predicted Time 2 measures of well-being, after controlling for Time 1 measures of well-being. Specifically, ineffective problem orientation predicted increases in anxiety and stress, and decreases in positive affect. Difficulty identifying and describing emotions predicted increases in anxiety and decreases in positive affect. Finally, an aspect of difficulty managing emotions (i.e. rumination) predicted decreases in positive affect. Each emotional competence variable predicted unique variance after controlling for other significant variables. We discuss the implications of these findings for counselling practice.     

The fears of the counsellors: a qualitative study

The author begins this paper with the claim that fear is a relatively under-researched topic in counselling despite its prevalence. Ten counsellors were interviewed concerning their fears encountered in their therapeutic work. Participants were also asked what they had found to be helpful and unhelpful when attempting to deal with these fears. Fears reported are categorised into fears of losing control, fears of being separated from a group by way of disapproval or rejection, and fears of physical and/or sexual assault. Substantive quotations are provided from the interviews. The author concludes with the contention that a deeper consideration and enhanced understanding of counsellors' fears will assist counsellors and their supervisors to accord fear an appropriate and healthy respect without becoming unduly frightened in the process.     

Embodying sexual subjectivity after cancer: A qualitative study of people with cancer and intimate partners

Research has increasingly recognised the profound impact that cancer can have upon embodied subjectivity. However, there has been little acknowledgement of the centrality of sexuality to subjectivity, and marginalisation of the experiences of intimate partners of people with cancer. This Australian qualitative study explores the post-cancer experiences of embodied sexual subjectivity for 44 people with cancer (23 women and 21 men) and 35 partners of people with cancer (18 women and 17 men) across a range of cancer types and stages. Semi-structured interviews were analysed with theoretical thematic analysis, guided by a post-structuralist approach to sexual subjectivity as a dynamic process of becoming that can change over time, and by Williams’ [(1996). The vicissitudes of embodiment across the chronic illness trajectory. Body and Society, 2, 23–47] framework on post-illness embodiment. Participants took up the following post-cancer subject positions: ‘dys-embodied sexual subjectivity’ – characterised by bodily betrayal, sexual loss, lack of acceptance, depression, and anxiety; ‘re-embodied sexual subjectivity’ – characterised by greater sexual confidence, acceptance, the exploration of non-coital sexual practices and increased relational closeness; and ‘oscillating sexual subjectivity’ – involving a shift between states of sexual dys-embodiment and sexual re-embodiment. The findings point to the importance of focusing on the sexual health of people with cancer and partners across the cancer trajectory.     

The regulation of subjective well-being in cancer patients: An analysis of coping effectiveness

Abstract

The hypothesis that individual coping efforts affect subjective well-being in the face of severe chronic disease is examined with questionnaire data from N=332 cancer patients in a one-year longitudinal study. After depicting conceptual and methodological requirements for the analysis of coping effectiveness, the following five coping modes were investigated in the sample: Rumination, search for affiliation, threat minimization, search for information and search for meaning in religion. Results from a series of hierarchical regression analyses yielded findings that questioned the underlying assumption of a general uniform causal direction within coping-adjustment relationships. Threat minimization proved to be the only coping mode that obviously was “effective” in well-being regulation, that is, was revealed to be predictive of well-being changes over time and to be unaffected by prior levels of well-being. It is argued that the problem of causal directionality has to be carefully examined in future studies on coping effectiveness since interindividual differences in coping behaviors might be a consequence rather than the cause of differences in adjustment status.     

Differences in perceptions on sexual and reproductive health between service providers and people living with HIV: a qualitative elicitation study

The sexual and reproductive health (SRH)-related needs of people living with HIV/AIDS (PLHA) have not been sufficiently recognised in research and clinical care. Fifteen study sites in 13 European countries participated in this qualitative study to assess differences in perceptions between service providers (SP) and PLHA on SRH-related problems and needs of PLHA. Factors influencing SRH were determined to collect evidence on how to improve service provision. Qualitative data were obtained using an interpretative ethnographical approach. Data were analysed inductively on country level; a cross country data matrix was developed to facilitate the contextual analysis. Thirty-seven FGD discussions were organised with a total of 254 participants. A short survey was distributed to assess demographic characteristics. Results revealed insufficient information and lack of behavioural skills regarding SRH issues among PLHA. Intra- and interpersonal, provider-related, and social factors were found to influence the SRH behaviours of PLHA. Although from patients' perception SRH is a prioritized issue, it rarely comes up during routine HIV clinical care. SP need adequate counseling training to tackle SRH-related issues. A better integration between HIV care programs and SRH care settings is needed to improve effective service provision.     

Preliminary study of reminiscence therapy on depression and self-esteem in cancer patients

The present study investigated use of life review, a form of reminiscence, on the depression and self-esteem in cancer patients. 15 cancer patients in the experimental group participated in individual reminiscence therapy. 21 patients in the comparison group received no therapy. All patients were measured on both depression and self-esteem scales during two testing periods. Analysis showed mean depression scores of the cancer patients decreased and mean self-esteem increased significandy after the life-review therapy sessions, while the scores of the comparison group did not change. Furthermore, patients' psychological states were improved, and they thought their problems had been addressed. These results suggest reminiscence therapy can be useful for cancer patients.     

Optimism,well-being,depressive symptoms,and perceived physical health: a study among Stroke survivors

The investigation of the relation of positive personality characteristics to mental and physical health among Stroke survivors has been a neglected area of research. The purpose of this study was to examine the relationship between optimism, well-being, depressive symptoms, and perceived physical health among Stroke survivors. It was hypothesized that Stroke survivors’ optimism would explain variance in their physical health above and beyond the variance explained by demographic variables, diagnostic variables, and mental health. One hundred seventy-six Stroke survivors (97 females, 79 males) completed the Revised Life Orientation Test, the Center for Epidemiological Studies Depression Scale, two items on perceived physical health from the 36-item Short Form of the Medical Outcomes study, and the Identity scale of the Illness Perception Questionnaire. Pearson correlations, hierarchical regression analyses, and the PROCESS approach to determining mediators were used to assess hypothesized relations between variables. Stroke survivors’ level of optimism explained additional variance in overall health in regression models controlling for demographic and diagnostic variables, and mental health. Analyses revealed that optimism played a partial mediator role between mental health (well-being, depressive symptoms and total score on CES-D) variables and overall health.     

The role of community context and psychological well-being for physical health: A dyadic study of military couples

Drawing from the social organizational theory of community action and change (SOAC) within a systemic biopsychosocial perspective, associations between community context (military community connections and satisfaction with military life), psychological well-being (depressive symptoms, anxiety, and self-efficacy), and physical health were examined for a sample of active duty service members and their civilian spouses (N = 236 couples) using an actor partner interdependence framework. Service members with higher levels of military community connections reported better psychological well-being. When civilian spouses were more satisfied with military life, both partners reported better psychological well-being. In turn, both spouses’ psychological well-being was related to their own reports of physical health. Statistically significant indirect effects were found between community contexts and spouses’ physical health. Enhancing community connections may be an important leverage point for supporting health and family readiness.     

Sex differences on a measure of conformity: comments on a recent study

Reysen and Reysen's recent article made a contribution to understanding of sex differences by interpreting the results through the lens of conformity research. Reinterpretation could refer to differences in perceptual sensitivity. The results, then, are theoretically and empirically consistent with the literature.     

Residence arrangements and well-being: a study of Norwegian adolescents

The purpose of this study was to assess any differences in psychosocial problems among adolescents living with both parents, or with their mother or their father. Any benefits of living with a same-sex parent compared to a parent of the opposite sex, was also analysed. A total of 1,686 adolescents aged 14-15 years participated from 29 schools in Hordaland county, including schools in downtown Bergen and more rural areas. The findings revealed significantly more psychosocial problems among the adolescents living with one parent compared to both parents. Significant differences were also observed between adolescents living in mother custody compared to father custody, indicating more problems among the latter group. Furthermore, girls living with their father had significantly higher levels of psychological symptoms, compared to boys in father custody. Similarly, boys living with their father were involved in more stealing behavior than girls in father custody. However, residence arrangement accounted for only a limited proportion of the variance in the adolescents' psychosocial problems, indicating large within-group variance and overlap between the different custody groups.     

The adolescent with myelomeningocele: a review of parent experiences and expectations

Until recently, persons born with spina bifida rarely lived to adulthood, and the severity of their physical and medical problems has been the source of litigation (e.g., Baby Jane Doe). This study questioned the parents of 39 adolescent survivors about their child's past medical history and psychosocial needs. While all of these adolescents had extensive histories of neurological and/or urological surgeries, most were mainstreamed into regular classroom settings. Three-fourths of the parents rated their adolescent as happy and outgoing. Less than 10% noted a predominant angry or depressed mood. The majority of adolescents had three or more close friends. About 10% stated that their child had problems with alcohol or drugs. Parents evaluated the support they had received on the medical and physical aspect of their child's illness as greater than that on psychosocial issues (e.g., sexuality, vocational needs). The desire for more assistance was expressed in these psychosocial areas (45% for sexuality and 68% for vocational needs) and in teenage issues (57%).