Relationships among depressive symptoms, benefit-finding, optimism, and positive affect in multiple sclerosis patients after psychotherapy for depression.

OBJECTIVE: While many patients with multiple sclerosis (MS) experience psychological problems, such as depression, benefit-finding is commonly reported. Using the Broaden-and-Build Model of positive emotions (Fredrickson, 2001) and the Expectancy-Value Model of optimism (Carver & Scheier, 1998) as two related, yet, distinct conceptual frameworks, this study examined positive affect and optimism as mediators of the relationship between improved depression and enhanced benefit-finding. DESIGN: MS patients (N=127), who participated in a larger, randomized clinical trial comparing two types of telephone psychotherapy for depression, were assessed at baseline, midtherapy (8 weeks), end of therapy (16 weeks), and 6- and 12-month posttherapy. MAIN OUTCOME MEASURES: Depression was measured with a telephone administered version of the Hamilton Rating Scale for Depression; Positive Affect was measured with the Positive Affect Subscale from the Positive and Negative Affect Scale; Optimism was measured with the Life Orientation Test-Revised; Benefit-Finding was measured with the revised version of the Stress-Related Growth Scale. RESULTS: Data were analyzed with multilevel random-effects models, controlling for time since MS diagnosis and type of treatment. Improved depression was associated with increased benefit-finding over time. The relationship between improved depression and benefit-finding was significantly mediated by both increased optimism and increased positive affect. CONCLUSION: Findings provide support to both theoretical models. Positivity appears to promote benefit-finding in MS.     

Knowledge and expectations: Perceived illness in myocardial infarction patients

In a study of 367 patients with myocardial infarction (MI), questionnaires were developed to assess two central aspects of perceived illness: factual and consensual illness knowledge and subjective expectations for the personal consequences of the MI. In a factor analysis, these two aspects of perceived illness were found to load on separate factors, and the patients views of the personal consequences of the MI were only moderately associated with their general cardiac health knowledge. Among a series of sociodemographic, medical, and psychological variables, including a standardized in-hospital patient education programme, the two aspects of perceived illness also proved to have different determinants. Differences in factual and consensual illness knowledge were mainly related to differences in formal education, and this aspect of perceived illness was influenced by the standardized education programme. In contrast, differences in subjective expectations were associated with levels of hopelessness. The implications for psychosocial interventions in the rehabilitation of MI patients are discussed.     

Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis.

Cancer patients experience positive as well as adverse consequences from diagnosis and treatment. The study reported here examined longer term reverberations of such experiences. A set of benefit-finding items along with measures of well-being were completed by 230 early-stage breast cancer patients in the year postsurgery. Four to 7 years later, 96 of them again completed measures of well-being. Controlling for initial distress and depression, initial benefit finding in this sample predicted lower distress and depression at follow-up.     

Subjective underemployment and psychosocial stress: the role of perceived social and supervisor support.

The purpose of this study was to examine the effects of subjective underemployment on psychosocial stress. The moderator effects of perceived social and supervisor support were also investigated. Data were collected during the summer of 1987 in a public utility governmental agency in the United States. The sample size was 212 with a 71% response rate. Multiple regression analysis was used to examine the relationship between subjective underemployment and psychosocial stress. As expected, the results revealed a significant positive relationship between subjective underemployment and five indexes of psychosocial stress. The interactions between subjective underemployment and social and supervisor support were not significant; however, the relationships were in the expected directions. Supervisor support was positive and significantly related to psychosocial stress, but social support was not.     

Mind over matter: cognitive - behavioral determinants of emotional distress in multiple sclerosis patients

Given the high incidence and unique symptomatology of depression in multiple sclerosis (MS) patients, the current study examined the role of cognitive and behavioral variables in predicting psychosocial adjustment in this population, in order to suggest psychotherapeutic interventions tailored specifically to MS patients. Data from 329 MS patients indicated that problem solving coping, acceptance coping, and challenge appraisals were associated with positive psychological adjustment (i.e., high life satisfaction, low depression and anxiety), whereas variables measuring disease severity (i.e., illness duration, subjective health status, and self-reported disability) were not associated with adjustment. These findings suggest that MS patients' psychological outcomes are more related to controllable cognitive and behavioral factors than to the physical effects of the disease. Consequently, it is expected that interventions that target these specific coping strategies and cognitive appraisals will be effective in treating the emotional effects of MS.     

Adversarial Growth in Patients with Multiple Sclerosis and their Partners: Relationships with Illness Perceptions,Disability and Distress

The purpose of this study was to investigate whether patients with multiple sclerosis (MS) and their partners show adversarial growth and to examine which psychological and disability variables contribute to this in patients and their partners. The study also investigated the relationship between growth and distress. Seventy-two patients with MS and their partners provided demographic information and completed measures of posttraumatic growth, illness perceptions, depression, cognitive function and disability. Both patients and partners showed adversarial growth, with patients reporting significantly higher growth than partners. The only significant predictor for patient growth was partner growth, and vice versa. Dissimilarity in illness representations between patients and their partners on the consequences of MS dimension, patient mood and patient growth accounted for significant variance in partner growth. The findings support the idea of a ‘communal search for meaning’ where patients and their partners experience the trauma of having a chronic illness and subsequently find positive aspects together.     

Finding benefit in breast cancer: Relations with personality,coping, and concurrent well-being

Cancer patients experience positive as well as adverse consequences from cancer diagnosis and treatment. The work reported here was part of an effort to characterize the experiences of benefit finding in breast cancer patients. A sample of 230 early-stage breast cancer patients completed a set of benefit finding items in the year post-surgery. This measure was then related to measures of concurrent coping, several aspects of psychosocial well-being, demographic variables, and several other personality traits. Benefit finding related positively to trait optimism, and to positive reframing and religious activity as coping reactions. Benefit finding related inversely to emotional distress, but was relatively unrelated to other measures of well-being.     

Psychosocial adjustment to and control of diabetes mellitus: differences by disease type and treatment

The relationship of diabetic patients' psychosocial adjustment to disease type, treatment mode, and indexes of control was examined in a representative community population. The psychometric properties of the Diabetes Educational Profile (DEP) and its application to psychosocial research in diabetes were also investigated. Findings support the reliability and validity of the DEP. Various measures of psychosocial adjustment were related to diabetes control but the specific relationships depended on the particular aspect of adjustment, the specific measure of diabetes control, and the type of disease and treatment. The findings suggest that analyses that aggregate dissimilar patient groups are subject to misinterpretation due to ecological masking and supressor effects. The results indicate that clinicians and researchers must recognize that patients with different disease types and treatment modes have different norms for psychological adjustment and diabetes control. Further, the particular aspects of psychosocial adjustment associated with diabetes control differ across patient groups.     

Negative expectations and bad relationships: Effects of negative metastereotypes on doctor–patient relationships

This research aimed to examine the effects of negative metastereotypes (i.e., patients believe that doctors have negative opinions about them) and conflict experience on doctor–patient relationships. A 2 × 2 experimental study was conducted on 84 outpatients who were randomly assigned to either a negative metastereotype activation (NMSA) condition or a nonnegative metastereotype activation (non‐NMSA) condition. Each group consisted of patients with and without conflict experience (CE). Intergroup anxiety and doctor–patient relationships were subsequently assessed. Results showed that NMSA and CE increased intergroup anxiety and undermined doctor–patient relationships. In addition, the interaction between NMSA and CE on doctor–patient relationships was significant. When negative metastereotypes were activated, patients with CE showed more unfavorable relationships with doctors as compared with those under non‐NMSA activation condition; no metastereotype effects on doctor–patient relationships were observed among patients without CE. These findings provided insights into an important predictor of doctor–patient relationships as well as its mechanism. Future studies should consider negative metastereotypes and CE to develop interventions for improving doctor–patient relationships.     

Current status of cannabis treatment of multiple sclerosis with an illustrative case presentation of a patient with MS, complex vocal tics, paroxysmal dystonia, and marijuana dependence treated with dronabinol

Pain, spasticity, tremor, spasms, poor sleep quality, and bladder and bowel dysfunction, among other symptoms, contribute significantly to the disability and impaired quality of life of many patients with multiple sclerosis (MS). Motor symptoms referable to the basal ganglia, especially paroxysmal dystonia, occur rarely and contribute to the experience of distress. A substantial percentage of patients with MS report subjective benefit from what is often illicit abuse of extracts of the Cannabis sativa plant; the main cannabinoids include delta-9-tetrahydrocannabinol (delta9-THC) and cannabidiol. Clinical trials of cannabis plant extracts and synthetic delta9-THC provide support for therapeutic benefit on at least some patient self-report measures. An illustrative case is presented of a 52-year-old woman with MS, paroxysmal dystonia, complex vocal tics, and marijuana dependence. The patient was started on an empirical trial of dronabinol, an encapsulated form of synthetic delta9-THC that is usually prescribed as an adjunctive medication for patients undergoing cancer chemotherapy. The patient reported a dramatic reduction of craving and illicit use; she did not experience the "high" on the prescribed medication. She also reported an improvement in the quality of her sleep with diminished awakenings during the night, decreased vocalizations, and the tension associated with their emission, decreased anxiety and a decreased frequency of paroxysmal dystonia.     

Marital role strain,illness intrusiveness,and their impact on marital and individual adjustment in end-stage renal disease

Abstract

A marital role theory approach was used to investigate individual psychosocial well-being and marital adjustment in 89 end-stage renal disease (ESRD) patients and their spouses. Four different patient groups were selected according to a continuum of clinical milestones in the treatment of ESRD, including pre-dialysis (n=17), incenter dialysis (n=18), home dialysis (n=19), and posttransplant patients (n=17). A nephrology clinic control group (n=18) was also included. Standardized instruments were employed to investigate marital role strain (Marital Role Questionnaire, KDS-15), marital adjustment (Locke-Wallace Marital Adjustment Test), subjective well-being (Affect Balance Scale, Rosenberg Self-Esteem Inventory), and psychopathology (Symptom Checklist 90-R). Hierarchical multiple regression analyses provided strong and consistent support for the major hypotheses relating elevated marital role strain to compromised marital adjustment and individual well-being. Further analyses demonstrated that increased perceived intrusiveness of ESRD was significantly related to greater marital role strain, poorer marital adjustment, and decreased individual well-being. This is consistent with the idea that perceived intrusiveness may be an important mediator of marital role strain and of coping with chronic illness. “Objective” intrusiveness, defined in terms of patient group, was not significantly related to marital or individual well-being. These findings support a dyadic approach to the psychosocial study of chronic illness.     

Perceived Norms,Outcome Expectancies,and Collegiate Drinking: Examining the Mediating Role of Drinking Motives

The authors examined the mediational role of drinking motives in explaining the associations among psychosocial antecedents and collegiate drinking. Results indicated that drinking motives partially mediated the relationships between outcome expectancies, perceived norms, alcohol use intensity, and alcohol‐related negative consequences.     

Subjective Age and Personality Development: A 10‐Year Study

Personality theory and research typically focus on chronological age as a key indicator of personality development. This study examines whether the subjective experience of age is an alternative marker of the biomedical and psychosocial factors that contribute to individual differences in personality development. The present study uses data from the Midlife in the United States longitudinal survey (N = 3,617) to examine how subjective age is associated with stability and change in personality and the dynamic associations between subjective age and personality traits over a 10‐year period. Regression analyses indicated that a younger subjective age at baseline was associated with increases in Openness, Conscientiousness, and Agreeableness; correlated changes were also found. The rank‐order stability of Extraversion and Openness and overall profile consistency were higher among those with a younger subjective age at baseline and were also associated with the rate of subjective aging over time. The present study reveals that beyond chronological age, the age an individual feels is related to changes in characteristic ways of thinking, feeling, and behaving over time.     

Effect of Depressive Symptoms and Sex on the Relationship Between Loneliness and Cigarette Dependence: A Moderated Mediation

Loneliness is a subjective and emotionally unpleasant experience of perceiving insufficient social relationships. Previous research has revealed that loneliness constitutes a psychosocial risk factor for depression, and is also related to unhealthy behaviors such as smoking. This study aims to examine the relation between loneliness, depression, and cigarette dependence, and to explore the role of sex in this relationship. A total sample of 275 adult treatment-seeking daily smokers (Mage = 45.3; 61.5% females) was used. Our results showed a significant correlation between higher scores of loneliness, depressive symptoms, and cigarette dependence. In addition, mediation analysis showed a significant indirect effect of loneliness on cigarette dependence, via depressive symptoms. Regarding the effect of sex, we found that this variable significantly moderated the relationship between depressive symptoms and cigarette dependence. Results of this study extend previous literature by showing that, in treatment seeking smokers, loneliness is a significant predictor of depressive symptoms, and through this relation, it predicts cigarette dependence. Additionally, sex was a significant moderator of this relation. These findings have several clinical implications, and also contribute to the understanding of cigarette dependence, which is a well-known barrier for smoking cessation.     

Young adult identities and their pathways: a developmental and life course model

Developmental and life course studies of young adult identities have focused on 2 dimensions: subjective age and psychosocial maturity. This study examines the developmental synchrony of these 2 processes. In a longitudinal sample of young adults from Add Health (ages 18-22), a person-centered analysis of indicators of these dimensions identified 4 identity profiles. Two depict early and late patterns of identity; the others represent contrasting types of discordance: pseudo-adult, with subjective age more advanced than maturation level, and anticipatory, with subjective age less advanced than maturational level. The profiles vary by gender, socioeconomic status, and race-ethnicity, as well as by adolescent (ages 12-16) pubertal maturation, psychosocial adjustment, and family context. These results provide support for a more holistic, interdisciplinary understanding of adult identity and show that young adult identities in the Add Health sample follow differentiated paths into the adult years, with largely unknown consequences for the subsequent life course.     

Predicting Intentions to Use Condoms: A Meta-Analysis and Comparison of the Theories of Reasoned Action and Planned Behavior1

A meta-analysis was conducted on 23 psychosocial predictors of intentions to use condoms. Data from 67 independent samples were included in the review. Findings demonstrated that demographic, sexual experience, and personality variables had small average correlations with intentions. Knowledge about HIV/AIDS and perceptions of the threat of disease were also weakly related to decisions about using condoms. Attitudes and subjective norms from the theory of reasoned action, on the other hand, demonstrated medium to strong effect sizes. Two components of social influence not specified by the theory of reasoned action also received support. Evidence suggested that perceived behavioral control from the theory of planned behavior was a reliable predictor of behavioral intentions and explained variance over and above the effects of attitudes and subjective norms.     

Time perspective,socioeconomic status,and psychological distress in chronic pain patients

Time perspective (TP) is a fundamental dimension of the psychological construction of time. It refers to a subjective experience and can be defined as the relationship that individuals and groups have with the present, past, and future. Studies have shown that it is interesting to take into account TP in the field of health, especially for the study of the psychological distress (PD) of individuals faced with aversive situations. We conducted a research, which aimed to explore the relationship between TP and PD in patients with chronic pain. A total of 264 first-time patients (72.3% women; mean age = 49 years) at CHU Timone (Marseille) pain center answered a questionnaire included TP, socioeconomic status, pain beliefs (PB), pain characteristics, and sociodemographic characteristics. Using hierarchical regression analyses adjusted to the characteristics of pain, sociodemographic characteristics, and PB, we can observe significant relationships between different components of TP, socioeconomic status, and PD. These results emphasize the importance of TP as psychosocial variable in the analysis of PD in patients with chronic pain. These results also lead us to point out the role of the socioeconomic status that predicts levels of PD.     

Does Defensiveness Account for the Relationship Between Religiosity and Psychosocial Adjustment?

Religiosity has been related to positive psychosocial adjustment across a large number of studies. Some researchers question, however, whether this relationship is an accurate finding, observing that there are many potential confounds that have not been controlled for, such as defensiveness. This study examined whether defensiveness accounted for the relationship between religiosity and psychosocial adjustment. Two samples of religious individuals were assessed on religiosity (Duke University Religion Index), defensiveness (measured using the denial of distress and repressive defensiveness subscales from the Weinberger Adjustment Inventory [WAI]), and psychosocial adjustment (Depression subscale from the WAI, the Perceived Stress Scale, and the Sarason Social Support Scale). In both studies it was found that religiosity was related to positive psychosocial adjustment as well as higher levels of defensiveness. Defensiveness, however, did not account for the relationships between religiosity and psychosocial adjustment. These findings add to the research literature by eliminating a potential confound of the relationship between religiosity and psychosocial adjustment.     

Never quite good enough: The paradox of sticky developmental relationships for elite university graduates

Drawing on the mentoring, education, and social psychology literatures, this longitudinal study examines how the persistence of developmental relationships from an elite graduate school influences subjective career outcomes during early career. Participants (n = 136) were surveyed about their developmental networks—a group of individuals who take an active interest in and action to advance a focal individual’s career—and subjective career outcomes over the 10 years (1996-2006) post graduation. Results show that although receiving mentoring from one’s entire developmental network was positively related to career-related self-efficacy and perceptions of career success, this was not the case for ties retained from graduate school. Continuing to receive mentoring support from developers from graduate school and further, from peers from graduate school, was negatively related to perceptions of career success. These findings offer insight into the dynamics and potentially negative consequences of developmental networks and highlight the significance of social comparison during early career.