Intrusive thoughts and avoidance in breast cancer: Individual differences and association with psychological distress

Abstract Eighty-five women with newly diagnosed breast cancer were classified on the basis of high and low levels of cancer-related intrusive thoughts and avoidance at diagnosis, and their psychological adjustment was studied prospectively at 3 and 6 months post diagnosis. Patients who initially reported high levels of both intrusive thoughts and avoidance and those who reported high levels of intrusive thoughts but low avoidance experienced the highest levels of anxiety and depression symptoms, and continued intrusive thoughts and avoidance. Patients who were high in avoidance but low in intrusive thoughts also experienced adjustment problems, including increased intrusive thoughts, when compared with patients who were low in both types of symptoms. The findings highlight the value of considering subgroup differences in patterns of intrusion and avoidance as predictors of subsequent psychological adjustment to breast cancer.     

Intrusive thoughts and avoidance in breast cancer: Individual differences and association with psychological distress

Abstract

Eighty-five women with newly diagnosed breast cancer were classified on the basis of high and low levels of cancer-related intrusive thoughts and avoidance at diagnosis, and their psychological adjustment was studied prospectively at 3 and 6 months post diagnosis. Patients who initially reported high levels of both intrusive thoughts and avoidance and those who reported high levels of intrusive thoughts but low avoidance experienced the highest levels of anxiety and depression symptoms, and continued intrusive thoughts and avoidance. Patients who were high in avoidance but low in intrusive thoughts also experienced adjustment problems, including increased intrusive thoughts, when compared with patients who were low in both types of symptoms. The findings highlight the value of considering subgroup differences in patterns of intrusion and avoidance as predictors of subsequent psychological adjustment to breast cancer.     

Life stressors, emotional avoidance and breast cancer

Two groups of women were assessed in psychological aspects considered by some authors of interest for personal well-being. The sample consisted of 118 women, 58 diagnosed with breast cancer and 60 healthy women, of similar ages and personal circumstances. The purpose of the study was: (a) to explore the existence of stressful life events in the women's history and their degree of subjective distress and (b) to determine whether or not there is an emotional avoidance style in the group of women with breast cancer. The following assessment instruments were employed: the "Cuestionario de Formas de Afrontamiento" (CEA), the Five-Factor Inventory NEO-PI-R, and the State-Trait Anger Inventory (STAXI). The results revealed more stressful vital events in the last two years in the group of women with breast cancer and significant differences in the degree of current distress. They also obtained higher scores in current anger, resignation, and neuroticism.     

Dispositional and stressor-related emotion regulation in the context of a chronic, life-limiting stressor

In the context of efforts to regulate emotion during chronic stressors, both dispositional response tendencies (affect intensity, negative and positive expressivity) and stressor‐related coping through emotional approach (processing and expressing emotions) are relevant to adjustment. In women with metastatic breast cancer (N = 103), contributions of self‐reported emotional processing and expression related to cancer, as well as dispositional expressivity to adaptive outcomes across 3 months were examined. In the context of high dispositional expressivity, an increase in emotional expression predicted improvements in depressive symptoms and life satisfaction. Emotional processing at study entry predicted increased depressive symptoms and intrusive thoughts, and declining life satisfaction among highly expressive women. Increasing emotional processing predicted improved depressive symptoms in the context of high expressivity. Increases in emotional approach coping were associated with a more arduous cancer experience. Findings highlight the importance of the person‐situation fit in linking emotion‐related constructs to adjustment during unremitting stressors.     

Relationship of social support and social burden to repeated breast cancer screening in the women's health initiative.

Direct and interactive effects of social support, social burden (caregiving, negative life events, and social strain), education, and income on repeated use of breast cancer screening among a large (N=55,278), national sample of postmenopausal women participating in the Women's Health Initiative observational study were examined. Repeated screening decreased as emotional/informational support and positive social interactions decreased (ps<.01). Repeated mammography decreased with frequent caregiving (p<.01). Less social strain reduced the frequency of repeated breast self-examinations (BSEs; ps<.01), but frequent caregiving and more negative life events increased repeated use of BSE (ps<.01). Interactive effects suggested that emotional/informational but not tangible support is associated with repeated mammography and clinical breast examinations (ps<.01) and may be particularly important among low-income older women, especially those burdened by caregiving.     

Intrusion, avoidance, and daily negative affect among couples coping with prostate cancer: a dyadic investigation

In the present study we examined how husbands' and wives' intrusive thoughts of prostate cancer (i.e., thinking about it when not meaning to) and avoidance (i.e., efforts to not think about cancer) related to their own and each other's average negative affect over a subsequent 14-day period. We examined whether congruence or similarity in intrusion about illness, but not avoidance, would be associated with less negative affect as this response to cancer could potentially facilitate adjustment. Fifty-nine husbands and wives completed measures of intrusion and avoidance after the diagnosis of prostate cancer and reported on their daily negative affect for 14 days. Using the actor-partner interdependence model, both patients and their wives who had high levels of intrusive thoughts experienced less negative affect when the other member of the couple also experienced high levels of intrusive thoughts. Those who had higher levels of avoidance had spouses who had higher levels of negative affect regardless of their own levels of avoidance. Congruence in responses to cancer may be adaptive for intrusion but not avoidance because the use of intrusive thoughts by both husbands and wives can allow couples to process the diagnosis of cancer, facilitating psychological adjustment, whereas avoidance does not. The current investigation adds to our understanding of how people within a marital dyad affect each other as they adjust to a cancer diagnosis.     

Unmitigated agency, social support, and psychological adjustment in men with cancer

Unmitigated agency (UA), a gender-linked characteristic, has been associated with poorer cancer adjustment. Support from one's social network typically predicts adjustment but may be poorly matched to UA. The influence of UA on the utility of social support on adjustment over time is examined. Men with cancer (N=55) were assessed initially and 6 months later on three indicators of adjustment. Multilevel modeling analyses varied by adjustment indicator. UA was associated with increased cancer-related psychosocial symptoms but not depressive symptoms or cancer-related thought intrusion. Social support predicted fewer depressive symptoms and less cancer-related thought intrusion. However, a cross-level interaction revealed that the utility of social support on cancer-related thought intrusion was weaker for men with greater levels of UA. Men with cancer likely respond differently to changes in social support depending on their endorsement of UA.     

Intrusive memories and depression in cancer patients

Matched samples of depressed and nondepressed cancer patients were interviewed about past life events, particularly experiences of death and illness. They identified and described any spontaneous intrusive visual memories they had experienced in the past week corresponding to these events. About one quarter reported such memories and, as predicted, the majority of intrusive memories concerned illness, injury and death. The mean levels of intrusion and avoidance were equivalent to patients with post-traumatic stress disorder. Consistent with prediction, depressed patients reported significantly more intrusive memories than controls, and described the memories as typically beginning with or being exacerbated by the onset of depression. Greater numbers of intrusive memories were associated with more maladaptive coping, and greater avoidance with deficits in autobiographical memory functioning.     

Sex drive, attachment style, relationship status and previous infidelity as predictors of sex differences in romantic jealousy

Recent research examining sex differences in jealousy suggests that more men than women tend to be distressed by sexual infidelity, and that more women than men tend to be distressed by emotional infidelity. The primary explanation for these findings is that evolution has shaped men’s and women’s responses to enhance their chances of reproductive success. However, within-sex differences are also found in terms of relative level of distress at sexual or emotional infidelity. This study examined the effect of alternative variables, particularly those associated with attachment and sexual motivations, on both between- and within-sex differences in relative distress at sexual and emotional infidelity. A community sample of 437 adults provided data using a self-report questionnaire. The results showed that sex drive was a significant predictor of distress at jealousy for both men and women, while attachment avoidance and previously being the victim of a sexual infidelity were significant predictors for men only, and relationship status was a significant predictor for women only. Overall, these findings support the evolutionary model of jealousy, and suggest that sex-specific evolved psychological mechanisms underpinning jealousy are influenced by attachment and sexual motivations.     

Stability and change in stress, resources, and psychological distress following natural disaster: Findings from hurricane Andrew

Abstract The stress, resource, and symptom levels of 241 residents of southern Dade County, Florida were assessed 6 and 30 months after Hurricane Andrew. Percentages meeting study criteria for depression and PTSD did not change over time. Whereas mean levels of intrusion and arousal decreased, depressive symptoms remained stable, and avoidance/numbing symptoms actually increased. Intrusion and arousal were associated more strongly with pre-disaster factors (gender, ethnicity) and within-disaster factors (injury, property loss) than with post-disaster factors (stress, resources), but the reverse was true for depression and avoidance. Changes over time in symptoms were largely explained by changes over time in stress and resources. The findings indicate that ongoing services are needed to supplement the crisis-oriented assistance typically offered to disaster victims.     

The influence of breast cancer survivors' Perceived partner social support and need satisfaction on depressive symptoms: A longitudinal analysis

The present study examines the ways in which breast cancer survivors’ perceptions of emotional and instrumental social support from an intimate partner and need satisfaction in their partner role influence depression during and after breast cancer treatment. Our sample was comprised of 163 women who were an average of 57 years old, mostly White/Caucasian, and diagnosed primarily with early-stage breast cancer. Longitudinal data were analysed using both multilevel and structural equation modelling. Results reveal that (a) greater perceived partner emotional support is associated with lowered levels of depression at each wave, (b) partner-role need satisfaction mediates the relationship between perceived partner emotional support and depression at each wave, (c) perceived partner emotional support predicts subsequent changes in depression by way of need satisfaction and (d) depression prospectively predicts lowered perceptions of partner emotional and instrumental support. The findings confirm that basic need satisfaction, within intimate relationships, is an important predictor of lowered depression among breast cancer survivors.     

Seeing the silver lining: cognitive reappraisal ability moderates the relationship between stress and depressive symptoms

Individuals differ in their adjustment to stressful life events, with some exhibiting impaired functioning, including depression, while others exhibit impressive resilience. The present study examined the hypothesis that the ability to deploy a particularly adaptive type of emotion regulation-cognitive reappraisal-may be a protective factor. It expands upon existing research in three ways. First, participants' ability to use reappraisal (cognitive reappraisal ability: CRA) was measured by using a behavioral challenge that assessed changes in experiential and physiological domains, rather than questionnaires. Second, all participants had been exposed to one or more recent stressful life events, a context in which emotion regulation may be particularly important. Third, a community sample of 78 women aged 20 to 60 was recruited, as opposed to undergraduates. Results indicate that, at low levels of stress, participants' CRA was not associated with depressive symptoms. However, at high levels of stress, women with high CRA exhibited less depressive symptoms than those with low CRA, suggesting that CRA may be an important moderator of the link between stress and depressive symptoms.     

Self-reported psychological stress and the risk of breast cancer: a case-control study

The aim of this study was to examine the relationship between severe life events and breast cancer risk. This study was based on a case-control examination of 858 Polish invasive breast cancer cases and 1085 controls matched for age and place of residence. Data on life events, sociodemographic characteristic, reproductive factors, family history of breast cancer, current weight and height, and lifestyle habits were collected between January 2003 and May 2007 using a self-administered questionnaire. Odds ratios with 95% confidence intervals were estimated as the measure of the relationship between life event stress and breast cancer risk using unconditional logistic regression analyses. After adjustment for potential breast cancer risk factors, women with four to six individual major life events had 5.33 times higher risk for breast cancer, compared with those in the lowest quartile. Similarly, women with a lifetime life change score greater than 210 had about 5 times higher risk compared to women with corresponding scores in the range 0-70. Several life events (death of a close family member, personal injury or illness, imprisonment/trouble with the law, retirement) were significantly associated with breast cancer risk. These findings suggest that major life events can play an important role in the etiology of breast cancer.     

Chronic stress,acute stress,and depressive symptoms

Although life events continue to be the major focus of stress research, recent studies suggest that chronic stress should be a more central focus. An evaluation of this issue is presented using data from a large community survey of married men (n = 819) and women (n = 936). Results show that chronic stresses are more strongly related to depressive symptoms than acute stresses in all but one life domain. The interaction patterns exhibited by chronic and acute stresses are predominantly associated with lower levels of depression than those predicted by a main effects model. This pattern suggests that chronic stresses may reduce the emotional effects of acute stresses. Although the processes through which this effect occurs are not clear, it is suggested that anticipation and reappraisal reduce the stressfulness of an event by making its meaning more benign. Implications for future research on chronic and acute stress effects are discussed.     

Effectiveness of therapy group in women with localized breast cancer

Background/ObjectiveBreast cancer causes high levels of anxiety and depression, deteriorating quality of life of patients. Several studies have found that group therapy reduces depression and anxiety also improves the quality of life. The aim of this study is to analyze group therapy effectiveness in emotional state and quality of life in women with breast cancer after finalized medical treatments.MethodParticipants in this study were 100 adult women diagnosed of breast cancer non-mestastasic and were divided into two types of intervention groups (Self-esteem-Social Skills and Cognitive-Behavioral Therapy). Evaluation instruments were questionnaire Functional Assessment of Breast-cancer Therapy (FACT-B) and Hospital Anxiety and Depression Scale (HADS).ResultsA statistically significant effect of group therapy in reducing anxiety and depression were observed. Quality of life and emotional well-being significantly improved. These effects remain three months after intervention.ConclusionsThe results show that the psychological intervention group is efficient to improve emotional state and quality of life of women with breast cancer.     

Gender,Emotional Support,and Well-Being Among the Rural Elderly

The current study sought to clarify the effects of social support on the psychological well-being of rural elders. Data were provided by 180 older men and women (mean age = 73.6 years) living in Northern Appalachia. Similar to the demographic profile of this region, most (97.2%) of the participants were Caucasian. Although mean differences in perceptions of emotional support did not emerge, the relative importance of various sources of support differed for men and women. For men, higher satisfaction with family support was associated with lower negative affect and higher positive affect. For women, although satisfaction with emotional support from family and more years of education were associated with lower levels of negative affect, emotional support from friends enhanced positive affect. The results suggest that new programs may be needed in order to help older rural men and women to maintain well-being in late life.     

Coping and Emotional Distress in Primary and Recurrent Breast Cancer Patients

The purpose of this study was to explore the emotional distress and coping strategies among women with primary as against recurrent (local or metastatic) breast cancer. The study sample consisted of 80 women, all 1 year postdiagnosis of primary or recurrent breast cancer. All women completed a demographic questionnaire, the Emotional Symptoms Checklist (SCL-90R) and the Ways of Coping Questionnaire (WCQ). Patients with recurrence reported higher levels of depression and anxiety as well as a higher global severity index (GSI). This group used significantly fewer problem-solving and positive-focus strategies. Emotion-focused coping predicted depression and the GSI, but only positive attitude predicted the level of anxiety. The state of disease was a major predictor of emotional symptoms, and to a lesser extent of the coping strategies used. Although emotion-focused coping had a deleterious effect on emotional well-being, our study highlighted the importance and relevance of positive attitude for reducing emotional distress in general and level of anxiety in particular. Promotion of positive-focus coping strategies should thus be a key element in psychological interventions with cancer patients.     

Predictors of relationship adjustment among couples coping with a high risk of developing breast/ovarian cancer

This study investigated the association between supportive and collaborative processes and dyadic adjustment in 94 women at increased risk of breast/ovarian cancer and their partners. Participants were recruited through two familial cancer clinics. They completed mailed, self-report questionnaires that included measures of psychological distress, dyadic adjustment (consensus, cohesion and satisfaction) and couple predictor variables (perceived support and team approach). Most couples reported average-to-high levels of consensus, cohesion and satisfaction, with a small proportion of couples (6.4%) reporting scores that reached clinically significant levels of dyadic distress. Greater perceived support was associated with better dyadic consensus and satisfaction, and dyadic cohesion and satisfaction were higher among couples who reported greater use of a team approach. General distress did not moderate the association between dyadic coping and relationship quality. There were no significant relationships between intra-couple congruence on support or team approach, and dyadic adjustment. Most couples had a functional relationship in the face of the current health stressor, although a subgroup may be at elevated risk of negative psychological consequences, including further relationship strain. The results highlight that dyadic coping strategies are important factors involved in the quality of couples' relationship following genetic counselling for breast/ovarian cancer risk.     

Coping and social support and health related quality of life in women with breast cancer in Turkey

This study aims to investigate the role of social support and coping in explaining health related quality of life (HRQoL) among Turkish breast cancer patients. A cross-sectional sample of 188 women from three hospitals in Turkey completed the Multidimensional Scale of Perceived Social Support, the Ways of Coping Inventory, and the Short Form 36 Health Survey. Socio-demographic and medical information was also collected. Results indicated high HRQoL levels, with 7 of the 10 SF-36 scores being within 1 SD of population mean. Correlations showed that helplessness coping was inversely associated with HRQoL whereas social support, religious coping, optimistic coping and problem focused coping were positively associated with HRQoL. Multiple regressions indicated that time since diagnosis, time since operation, stage of cancer, post-operative treatment, social support and problem solving coping were significant predictors of HRQoL accounting for 54.7% to 46.4% of the variance in physical and emotional HRQoL. Coping and social support have an independent effect on HRQoL over and above sociodemographic and medical variables and should be targeted by appropriate interventions.     

Perceived partner support and psychosexual adjustment to breast cancer

Support from a partner can play a key role in a woman's emotional adjustment to breast cancer. However, little is known about the influence of partner behaviours on a woman's sexual adjustment. This study examined the prospective relationship between baseline levels of several types of perceived partner support (instrumental, informational, emotional and negative) and psychosexual adjustment (sexual functioning and relationship satisfaction) over the course of 12 months post-surgery in a sample of 130 women with breast cancer. Results indicated that perceptions of greater emotional and informational support from the partner at baseline were associated with less sexual difficulties among breast cancer patients concurrently and 6 months post-surgery. Baseline perceptions of greater emotional and instrumental support from a partner were associated with greater relationship satisfaction at all time points. Perceptions of informational support at baseline were related to greater concurrent relationship satisfaction. Baseline perceptions of negative partner support were related to less relationship satisfaction, but only concurrently. These findings suggest that the perception of a partner's provision of emotional, instrumental and informational support may each play a role in facilitating sexual adjustment and relationship satisfaction.