Coping among african-american,hispanic, and non-hispanic white women recently treated for early stage breast cancer

Relatively little is known about how members of minority groups cope with experiences such as diagnosis and treatment of breast cancer – in particular, whether coping patterns among minorities differ from that of the majority. This study adds to the existing knowledge base using a cross-sectional sample of middle-class African-American (n = 26), Hispanic (n = 59), and non-Hispanic White women (n = 151) who had been treated for early stage breast cancer in the past year. We tested for differences in coping responses per se and also for the possibility that coping would relate to distress differently in different groups. There were only two differences in coping (controlling for medical variables, education, and distress): compared to non-Hispanic White women, the other two groups both reported using humor-based coping less, and religion-based coping more. There was one difference in how coping related to distress: venting related more strongly to elevated distress among Hispanic than among non-Hispanics. Discussion centers on a growing consensus on ethnic differences in religious and humor-based coping, and on the relative absence of other coping differences among these populations.     

Partner unsupportive responses, avoidant coping, and distress among women with early stage breast cancer: patient and partner perspectives.

This 18-month longitudinal study examined the associations among partner unsupportive behavior, avoidant coping, and distress experienced by 219 women with early stage breast cancer. The role of patient and partner ratings of unsupportive behavior were evaluated. Results indicated that patient and partner ratings of unsupportive behavior were highly correlated. Growth curve modeling suggested that unsupportive behavior, from both patient and partner perspectives, predicted more avoidant coping and distress. When partner and patient perceptions were placed in the same model, patient perceptions mediated the association between partners' ratings of their unsupportive behavior and patient distress. Avoidance also mediated the association between unsupportive behavior and distress, extending prior cross-sectional findings. Results highlight the long-term detrimental effects of partners' unsupportive behavior on the quality of life of women with early stage breast cancer.     

Negative affect and sensitization to pain

Pain usually has a strong negative affective component, which is believed to modulate pain perception. After reviewing theories on the link between negative affect and pain, mechanisms are discussed by which negative affect may either increase or inhibit pain. Possible pain-inhibiting mechanisms are endogenous opioid release, blood pressure reactivity, and distraction of attention; possible pain-increasing mechanisms are autonomic and muscular reactivity, misattribution of arousal, hypervigilance to pain, worrying, and avoidance behavior. It is emphasized that each of these mechanisms can be very adaptive in acute pain situations to prevent injury and promote recovery. In chronic pain, however, ongoing physiological arousal and hypervigilance to pain, induced or magnified by negative affect, may cause sensitization to pain. Furthermore, worrying about pain and avoidance of pain-inducing activities may increase negative affect, ypervigilance, and functional disability. It is argued that, in the long run, pain-related negative affect has sensitizing and disabling effects.     

Integrating stage and continuum models to explain processing of exercise messages and exercise initiation among sedentary college students.

Concepts from the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992), theory of planned behavior (I. Ajzen, 1985), and the elaboration likelihood model (R.E. Petty & J.T. Cacioppo, 1986b) were used to examine how exercise readiness impacted processing of exercise messages and exercise initiation. Sedentary college students (n = 147) were assessed for exercise attitude, intent, behavior, and stage of change. Students also listed their thoughts after reading messages with either strong or weak arguments for exercise. Attitude predicted depth of message processing, but stage of change did not. Stage of change and intent at baseline predicted exercise adoption at 1- to 3-month follow-up (n = 134), with baseline activity moderating the effect of intent. Tailoring messages to recipients' depth of processing and interactive effects of intent and behavior on exercise adoption should be considered in future research.     

Rethinking barriers: a novel conceptualization of exercise barriers in cancer survivors

Previous research suggests different types of barriers may demonstrate different relationships with intention to engage in health behaviors. This study explored global, practical, and health-related barriers’ relationships with exercise intention and behavior among cancer survivors. The mediating role of intention in the barriers-behavior relationships was also evaluated. Cancer survivors (N = 152) completed self-report measures of exercise barriers, intention, and behavior at baseline and of exercise behavior two months later. Global barriers were negatively related (p < .01) and practical and health-related barriers were unrelated (ps ≥ .07) to exercise intention. Global and practical barriers were negatively related (ps < .01) and health-related barriers were unrelated (p = .48) to subsequent exercise behavior. Exercise intention did not mediate any barriers-behavior relationships. Results suggest that global and practical barriers should be targeted in barriers reduction interventions and highlight the intention-behavior gap problem. Future research should explore multidimensionality of barriers for other health behaviors.     

An exploratory study of social support, distress, and life disruption among low-income Hispanic women under treatment for early stage breast cancer.

Relationships between distress and perceived availability of social support were examined in 51 Hispanic women being treated for early stage breast cancer. Distress and different types (emotional, instrumental) and sources (spouse, women family members, other family members, friends) of support were measured at presurgery, postsurgery, and at 3-, 6-, and 12-month follow-ups. Emotional support from friends and instrumental support from spouse at presurgery predicted lower distress postsurgery. No other prospective benefits of perceived support emerged. Distress at several time points predicted erosion of subsequent support, particularly instrumental support from women in the family. In contrast to the adverse effects of distress (and independent of them), illness-related disruption of recreational and social activities at 6 months elicited greater support at 12 months.     

Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer.

Concepts from the health belief, transtheoretical, and dual process models were used to examine how siblings of individuals diagnosed with colorectal cancer (CRC) before age 56 made decisions about CRC screening. Siblings (N = 504) were assessed for CRC screening practices and intentions, pros, cons, processes-of-change, perceived risk of CRC, perceived severity of CRC, preventability of CRC, cancer-related distress, and sibling relationship closeness. Physician and family recommendation and knowledge were also assessed. Fifty-seven percent of participants (n = 287) were compliant with CRC screening. Logistic regression indicated that perceived pros and cons, perceived risk, commitment to screening, health care avoidance, and sibling closeness were associated with screening compliance. Physician and family recommendation were also strong correlates. A similar set of factors was associated with stage of adoption of CRC screening.     

Social-cognitive processes as moderators of a couple-focused group intervention for women with early stage breast cancer.

OBJECTIVE: The purpose was to examine whether social-cognitive variables would moderate the efficacy of a couple-focused group intervention (CG) for women diagnosed with early stage breast cancer. DESIGN: Participants (N = 238) were randomly assigned to 6 sessions of a couple-focused group versus usual care. Intent to treat growth curve modeling analyses indicated that emotional expression and emotional processing moderated CG effects on depression. MAIN OUTCOME MEASURES: The primary outcome measures for this study were psychological distress and psychological well-being. RESULTS: Treatment attrition analyses separating out participants assigned to but not attending CG indicated that emotional expression, emotional processing, and protective buffering moderated the effects of CG among those who attended CG with the most consistent effects noted for emotional processing on indicators of distress and well-being. CONCLUSION: The CG intervention may be more effective for patients who begin the group experience using emotional approach coping strategies to deal with cancer.     

Negative support of significant others affects psychological adjustment in breast cancer patients

Significant others play an important role in providing support in patients' lives, but some types of support negatively affect the patients. This study was conducted in early-stage breast cancer patients to examine the structure of support, which was provided by their significant others and assessed negatively by the patients, and to identify negative support relating to the psychological adjustment of these patients. Thus, we first conducted interviews among 28 breast cancer patients to identify these support items assessed as negative; next, we conducted a questionnaire survey using the resulting items in 109 postoperative patients who had early-stage breast cancer. We performed exploratory and confirmatory factor analyses and obtained a valid second-order factor structure, including superordinate factors (excessive engagement, avoidance of problems and underestimation) and subordinate factors (overprotection, encouragement and management). Among these factors, the avoidance of problems was the only factor to be negatively associated with psychological adjustment of the patients, suggesting that these patients receive problem-avoiding support. The results of our study suggest that such problem-avoiding support from significant others can be counter-productive and potentially worsen the psychological adjustment of breast cancer patients.     

Negative support of significant others affects psychological adjustment in breast cancer patients

Significant others play an important role in providing support in patients’ lives, but some types of support negatively affect the patients. This study was conducted in early-stage breast cancer patients to examine the structure of support, which was provided by their significant others and assessed negatively by the patients, and to identify negative support relating to the psychological adjustment of these patients. Thus, we first conducted interviews among 28 breast cancer patients to identify these support items assessed as negative; next, we conducted a questionnaire survey using the resulting items in 109 postoperative patients who had early-stage breast cancer. We performed exploratory and confirmatory factor analyses and obtained a valid second-order factor structure, including superordinate factors (excessive engagement, avoidance of problems and underestimation) and subordinate factors (overprotection, encouragement and management). Among these factors, the avoidance of problems was the only factor to be negatively associated with psychological adjustment of the patients, suggesting that these patients receive problem-avoiding support. The results of our study suggest that such problem-avoiding support from significant others can be counter-productive and potentially worsen the psychological adjustment of breast cancer patients.     

Negative affect and hindsight bias

The relationship between hindsight bias and individual differences in negative affect, or ‘dysphoria’, was investigated in a naturalistic study. In a first session, 76 undergraduates predicted their grades prior to a midterm exam. In a second session, after having received feedback from the exam, they attempted to recall their predictions and predicted their grades on a second exam. Dysphoria was associated with hindsight bias whether initial predictions were overly optimistic or pessimistic. In the former case, the standard hindsight bias was modal for the sample, whereas a ‘reverse hindsight’ bias was modal in the latter. This asymmetry suggests that hindsight bias is influenced by motivational or affective factors. The bias did not hinder the improvement of predictions between the first and second exams, and therefore could not have mediated a hypothesized adaptive learning impairment among dysphoric subjects.     

Counterfactuals, coping strategies and psychological distress among breast cancer patients

The aim of this primary study was to predict the effect of counterfactuals, coping strategies, personal resources (age and education) and stage of the illness on psychological distress in a sample of 64 breast cancer patients. The main findings indicated that upward counterfactuals played an important role in the patients' psychological distress and coping process with the illness. Patients who used a high level of upward counterfactual thinking were found to have a high level of psychological distress. Downward counterfactual thinking, however, was not found to be related to less psychological distress.     

The distribution of repressive coping styles among non-metastatic and metastatic breast cancer patients as compared to non-cancer patients

Abstract

Recent investigations have shown increased disease progression among breast cancer patients with a “repressive” coping style characterized as: passive, conforming, inclined to deny physical symptoms and emotionally unexpressive. The Millon Behavioral Health Inventory (MBHI) scales which delineate three discrete repressive coping styles include the: Introversive, Cooperative and Respectful. Forty-four women recently diagnosed (within four weeks) with non-metastatic (N=32) or metastatic (N=12) breast carcinoma, responded to the MBHI upon admission for treatment of their disease at a cancer treatment unit. All subjects received mastectomy as well as chemotherapy, radiation and/or endocrine therapy. These 44 Cancer patients were compared to 34 control subjects, comprising women who were seen at a colposcopy clinic for follow-up of a suspicious pap smear which was ultimately shown to be benign or consisted of mild dysplasia. Non-metastatic, metastatic and control subjects were compared with respect to coping style and psychological distress. The breast cancer patients were more likely to employ a repressive coping style as compared to non-cancer patients who utilized a “sensitizing” coping strategy predominantly. Cancer patients with the most severe prognosis (metastasis) were the only group within the study to attain a clinically significant mean base rate score on the respectful scale. Results suggest that the incidence of repressive coping styles may be disproportionately high among breast cancer patients.     

Expressive disclosure and benefit finding among breast cancer patients: mechanisms for positive health effects.

A randomized trial (n = 60; A. L. Stanton, S. Danoff-Burg, L. A. Sworowski, et al., 2002) revealed that 4 sessions of written expressive disclosure or benefit finding produced lower physical symptom reports and medical appointments for cancer-related morbidities at 3-month follow-up among breast cancer patients relative to a fact-control condition. The goal of this article is to investigate mechanisms underlying these effects. Within-session heart rate habituation mediated effects of expressive disclosure on physical symptoms, and greater use of negative emotion words in essays predicted a decline in physical symptoms. Postwriting mood and use of positive emotion and cognitive mechanism words in essays were not significant mediators, although greater cognitive mechanism word use was related to greater heart rate habituation and negative emotion word use.     

Extending the activity restriction model of depressed affect: evidence from a sample of breast cancer patients.

Survey data from 95 women with Stage 1 (n = 36), Stage 2 (n = 49), or Stage 3 (n = 10) breast cancer both confirm and extend prior research indicating that restriction of normal activities is an important factor in depressed affect. Illness severity was directly related to more restricted routine activities, and more activity restriction was associated with higher public self-consciousness and less social support. Beyond the effects of age, self-consciousness, illness severity, and social support, activity restriction explained significant additional variance in symptoms of depression. Moreover, activity restriction mediated the impact of pain, public self-consciousness, and social support on depressed affect, which implies that these factors foster symptoms of depression by disrupting normal activities.     

Negative affect and interpersonal rejection among prison inmates in a therapeutic community: a social relations analysis.

The authors used D. A. Kenny's social relations model to examine J. C. Coyne's interpersonal theory of depression among a clinical sample of well-acquainted prison inmates. Members of 12 therapy groups (N = 142) diagnosed with a substance abuse disorder completed a self-report measure of depression and anxiety and indicated their desire to interact with other group members. There was both consensus about which group members were rejected and individual differences in the participants reported desire for future interaction with other group members. Those reporting high levels of depressive negative affect were most likely to be rejected. Those lowest in positive affect indicated the least desire for future interaction with others.     

Neuroticism and responses to social comparison among cancer patients

The present study examined how the effects of three audiotapes containing different types of social comparison information on the mood of cancer patients depended on the level of neuroticism. On the procedural tape, a man and woman discussed the process of radiation therapy, on the emotion tape, they focussed on emotional reactions to their illness and treatment, while on the coping tape they focussed on the way they had been coping. A validation study among 115 students showed that the tapes were perceived as they were intended. The main study was conducted among 226 patients who were about to undergo radiation therapy. Compared to patients in the control group, as patients were higher in neuroticism, they reported less negative mood after listening to the procedural and the coping tape. Furthermore, as patients were higher in neuroticism, they reported less negative mood after listening to the coping tape than to the emotion tape. Copyright © 2009 John Wiley & Sons, Ltd.     

Dispositional pessimism predicts illness-related disruption of social and recreational activities among breast cancer patients

The authors tested whether dispositional pessimism would predict withdrawal from social activities among women treated for breast cancer. In a cross-sectional sample 3-12 months postsurgery, disruption of social and recreational activities (measured by the Sickness Impact Profile) correlated with concurrently assessed pessimism. This association appeared mediated by emotional distress and fatigue. A longitudinal sample was studied shortly postsurgery and over the next year. Initial pessimism predicted disruption of social activities concurrently and prospectively (3, 6, and 12 months later) but predicted change in disruption from one time to the next only at final follow-up. These associations appeared partially mediated by distress. The authors conclude that pessimism places patients at risk for adverse outcomes in several respects rather than solely with regard to emotional distress.     

Perceived stigma,self-blame,and adjustment among lung,breast and prostate cancer patients

People who suffer from disease have often been stigmatised. The internalisation of stigma leads to the experience of self-blame. The relationship among stigma, self-blame and adjustment was framed with two theoretical perspectives: the looking-glass self and learned helplessness models. These models were studied in 96 lung, 30 breast and 46 prostate cancer patients. Consistent with the looking-glass-self model, we predicted that perceived stigma and self-blame would be associated with poorer psychological adjustment; the data supported these hypotheses. Consistent with the learned helplessness model, we predicted that self-blame would mediate the link between perceived stigma and psychological adjustment; data supported these hypotheses. The mediation model explained a greater percentage of the variance in adjustment in the lung cancer sample compared to the breast and prostate cancer sample. Participants who reported internal causal attributions reported poorer psychological adjustment. Lung cancer patients were more likely than breast or prostate cancer patients to report internal causal attributions for their cancer. Future research and cancer care are discussed in light of these findings.     

Psychosocial variables, external barriers, and stage of mammography adoption.

Guided by H. Triandis's (1980) theory of behavior and the transtheoretical model, the study purpose was to examine differences in psychosocial variables and external conditions by stage of mammography adoption. Sampled from a statewide population, participants (N=509) were women aged 51-80. They had been contacted by telephone, screened for eligibility (e.g., no history of cancer or recent mammogram), and interviewed 3-6 months later. Higher utility beliefs, social influences, and practitioner interactions about mammography were associated with improved stage of adoption, as were lower negative affect and external barriers regarding mammography. Higher decisional balance scores, with and without negative affect toward mammography were associated with improved stage. Controlling for variables reflecting pros and cons, negative affect toward mammography further distinguished among stages. A richer set of pros and cons measures could explain screening more fully.