Mental health consequences of weight cycling in the first-year post-treatment for breast cancer

Objectives: Weight cycling is linked with advanced breast cancer diagnosis, increased risk of cancer reoccurrence and cancer-related mortality. While women treated for breast cancer report challenges with navigating their post-treatment body shape and weight, the effects of weight cycling on body image and mental health have not been elucidated. This study examined associations between weight changes and weight cycling on psychological health (i.e. weight-related guilt, shame and depressive symptoms) among women in the first-year post-treatment.

Design and Outcome Measures: Self-reported assessments of pre-cancer weight cycling, post-treatment weight-related guilt, shame and depressive symptoms, and objective assessments of weight were assessed in a longitudinal sample of 173 women treated for breast cancer (M_age = 55.01 ± 10.96 years).

Results: Based on findings from multilevel models, women experienced the most weight-related shame when their weight was heavier than their personal average. Additionally, heavier weight was associated with worse psychological health, particularly for women with a history of stable (vs. cycling) weight pre-cancer.

Conclusions: Weight cycling pre-cancer and post-treatment weight change have important implications for psychological well-being. Due to the potential psychological consequences associated with a history of weight cycling, targeted strategies are needed to improve overall health outcomes for women’s survivorship after breast cancer.     

The Impact of Sexual Assault on College Students’ Daily Occupations: A Phenomenological Approach

Abstract

Sexual assault is associated with a high degree of Posttraumatic Stress Disorder (PTSD) severity. Three in ten survivors of campus sexual assault develop PTSD over their lifetime. Occupational therapists treat veterans with PTSD, but limited research exists addressing college student survivors of sexual assault and occupational therapy. A phenomenological approach was used to understand meanings of sexual assault for college student survivors. Semi-structured interviews yielded rich data and themes of disruption and reduced quality of life. The author concludes there is potential for occupational therapists to play a collaborative role on college campuses.     

Bibliotherapy for low sexual desire: evidence for effectiveness

This study examines the effectiveness of bibliotherapy for low sexual desire among women, which is the most frequent sexual concern brought to counselors. Forty-five women responded to an advertisement for participation in a study on low sexual desire and were assigned to either the intervention or the wait-list control group. The intervention group completed the Hurlbert Index of Sexual Desire (HISD; Apt & Hurlbert, 1992) and the Female Sexual Function Index (FSFI; R. Rosen et al., 2000), read the self-help book under study in 6 weeks, and completed the measures a second time. The control group completed the same measures 6 weeks apart. Results demonstrated that the intervention group made statistically greater gains over time as compared with the control group on measures of sexual desire (HISD and FSFI Desire subscale), sexual arousal (FSFI Arousal subscale), sexual satisfaction (FSFI Satisfaction subscale), and overall sexual functioning (FSFI Total Score). A subset of participants in the intervention group participated in a 7-week follow-up study, and these participants maintained their gains in sexual desire and overall sexual functioning. Findings have important implications for future research on the efficacy of bibliotherapy generally and for low sexual desire specifically. Results also have vital implications for the treatment of low sexual desire.     

A randomized controlled trial of expressive writing in breast cancer survivors with lymphedema

Objective: Breast cancer survivors who develop lymphedema report poorer quality of life (QoL) than those without lymphedema. Expressive writing is a potential intervention to address QoL.

Design: Adult women (N = 107) with breast cancer and chronic Stage II lymphedema were randomised to writing about thoughts and feelings specific to lymphedema and its treatment (intervention) or about daily activities (control) for four, 20-min sessions.

Main Outcome Measures: Outcome measures were several indicators of QoL assessed at baseline, one, three, and six months post-intervention (total scores and subscales of Upper Limb Lymphedema 27 and Functional Assessment of Cancer Therapy–Breast). Hypothesised moderators of change in QoL were dispositional optimism, avoidant behaviours, and time since lymphedema diagnosis.

Results: There was no statistically significant intent-to-treat main effects of expressive writing on QoL. Statistically significant moderating effects on change in different indicators of QoL were observed for all three moderators. Expressive writing was more effective for improving QoL in women who were higher on optimism, lower on avoidance and had less time since a lymphedema diagnosis.

Conclusion: These results provide further evidence that there are subsets of individuals for whom expressive writing is more effective. Future research may investigate targeting expressive writing based on identified moderators.     

A pilot study on the motivational effects of an internet-delivered physical activity behaviour change programme in Nova Scotian cancer survivors

Objective: To examine the effects of an internet-delivered, distance-based physical activity (PA) behaviour change programme on motivation to perform PA in cancer survivors.

Design: Breast, prostate and colorectal cancer survivors (N = 95) were randomized to either an online Theory of Planned Behaviour (TPB)-based PA behaviour change programme (UCAN) or usual care.

Main Outcome Measures: Motivational variables from the TPB including intention, planning, attitude, subjective norm, perceived behavioural control and underlying beliefs.

Results: UCAN had significant negative effects on self-efficacy (?.7; 95% CI = ?1.2 to ?.1; d = ?.53, p = .019), affective attitude (?.4; 95% CI = ?.8 to ?.0; d = ?.45, p = .044), instrumental attitude (?.5; 95% CI = ?.9 to ?.1; d = ?.43, p = .026) and confidence to perform PA in bad weather (?.8; 95% CI = ?1.6 to ?.1; d = ?.49, p = .030), despite health issues (?.7; 95% CI = ?1.3 to ?.1; d = ?.48, p = .031), despite pain/soreness (?.7; 95% CI = ?1.4 to ?.1; d = ?.52, p = .020), despite family responsibilities (?1.0; 95% CI = ?1.7 to ?.3; d = ?.62, p = .005) and when PA is boring (?.8; 95% CI = ?1.4 to ?.1; d = ?.54, p = .016).

Conclusion: UCAN had negative effects on motivational variables in cancer survivors. These findings may be explained by methodological issues related to measuring motivation and/or the absence of post-intentional constructs.     

Spirituality and Sexual Abuse: Issues and Dilemmas for Survivors

Abstract

Sexual abuse profoundly affects survivors to the extent that they are unable to maintain previously held viewpoints or ways of being, including those relating to their spirituality. Certainly the experience has considerable potential to complicate the spiritual lives of survivors. For Christian survivors, this may include how they perceive and relate to both themselves and God as well as affect participation in sacraments such as eucharist and reconciliation. Spiritual traditions often promote the embracing of silence, but this may be problematic for survivors who have been silenced and unable to give expression to their experiences. Similarly, socialization resulting in beliefs that Christians should always forgive and/or never be angry needs to be overcome. While negotiating these pitfalls may result in explorations of spirituality being even less straightforward for survivors of sexual abuse than it is for others, a transformative spirituality within a Christian framework can be realized.     

Intertransference: Transference Relationships between Members of the Psychotherapy Team

Abstract

There has been limited published research on the effectiveness of manualized psychoeducational approaches for the mental health and behavioral problems of child sexual abuse (CSA) survivors. The present study aims to add to the evidence base for the effectiveness and acceptability of such interventions. A total of 37 enrolled into a brief psychoeducation program (i.e., 10 sessions) aiming to help stabilize mental health and behavioral outcomes (e.g., self-harm), while on the waiting list for mental health services. Participants completed a set of self-rated measures at baseline, pre-intervention, post-intervention and 3-month follow-up. Although there was no change over time with regard to general distress, traumatic symptomatology, depression, anxiety, self-esteem, and life satisfaction, completers were less likely to report self-harm and presented with decreased rates of smoking, alcohol and substance misuse, and involvement in illegal and antisocial behaviors at post-treatment and follow-up. Qualitative data also suggested that overall the program is well tolerated by participants, despite the high attrition rate (43%). Although further research is required to establish the efficacy of this intervention, preliminary results indicate that the new intervention may be useful for stabilizing behavioral problems at post-treatment and follow-up. Strategies to improve attrition rates in future research and clinical practice are discussed.     

Sexual quality of life in patients undergoing coronary artery bypass graft surgery

Objectives: Despite improvements in many domains of functioning, sexual quality of life often remains impaired following coronary artery bypass graft (CABG) surgery. This study examined associations among sexual quality of life, fear of sexual activity and receiving information from providers about sexual activity in CABG patients.

Methods: Participants completed a survey assessing sexual activity, mental health and physical health at baseline (3–5-day post-surgery; n?=?60) and 2-month post-surgery (n?=?42).

Results: Sexual quality of life showed moderate difficulties at baseline and did not improve by follow-up (p values ≥0.09). At follow-up, greater patient fear was associated with lower sexual quality of life in some domains; receiving information was related to lower fear (p values ≤0.03) and greater sexual satisfaction and interest (p values ≤0.04). Suggestive of mediation, there was a significant indirect effect of information on patient fear and of patient fear on sexual interest (p?=?0.05).

Conclusions: Though data were cross-sectional, findings suggest that fears of sexual activity may play a role in lowering CABG patients’ motivation for sexual activity and that receiving information from a medical provider may assist in hastening sexual rehabilitation. Prospective and intervention studies are needed to support findings.     

Emotional approach coping: Gender differences on psychological adjustment in young to middle-aged cancer survivors

Objective : The effect of emotional approach coping (EAC) varies by gender. However, this gender difference has not yet been investigated in cancer survivors. We investigated whether the effects of two kinds of EAC – emotional processing (EP) and emotional expression (EE) – vary by gender and whether EAC has effects above and beyond the effect of other coping strategies.

Design : EAC and other coping strategies were assessed at baseline in a sample of 248 young to middle-aged adult (between the age of 22 and 55) cancer survivors. One hundred and sixty-six survivors responded to psychological adjustment one year later.

Results : EAC had different relationships with Time 2 adjustment in men and women. Hierarchical regression analyses showed that for men, EE predicted lower intrusive thoughts and, for women, EP was associated with higher positive affect when other coping strategies and EE were controlled.

Conclusion : Gender differences held true in cancer survivors, and EAC was effective when other coping strategies were controlled. Further, EE was effective in reducing negative adjustment in men while EP was helpful in promoting positive adjustment in women.     

The role of stressful life events on the cortisol reactivity patterns of breast cancer survivors

Objective: Atypical patterns of cortisol secretion following an acute stressor have been commonly reported in breast cancer survivors. Stressful life events have been associated with blunted acute cortisol levels in other populations. The purpose of this study was to explore the role of stressful life events on cortisol secretion patterns of breast cancer survivors following an acute stressor.

Design: The Trier Social Stress (TSST) was used to elicit a moderate stress response in breast cancer survivors (n = 19) and a control group (n = 17). Saliva samples were collected before, during and after the TSST to provide cortisol concentrations. During recovery, we recorded the frequency and subjective impact of stressful life events in the past year using the Life Experience Survey.

Results: Simple regressions analyses were performed; results suggest no group differences between the total number of stressful life events and their subjective impact. However, the total number of stressful life events as well as their subjective impact correlated negatively with the peak cortisol concentration in breast cancer survivors.

Conclusions: The cumulative effect of stressful life events, positive and negative, may impact the endocrine stress system of breast cancer survivors more so than that of women with no history of cancer.     

A Research Inquiry into Some American Women's Sexual Concerns and Problems

Abstract

The New View of Women's Sexual Problems is supported by findings of the 1993-94 Ellison/Zilbergeld sexuality survey of 2,632 mostly white, college-educated women born 1905-1977 (Ellison, 2000; see questionnaire at www.womenssexualities.com). Sexual experiences of women with previous year sexual partners are reported. The most important sexual concerns or problems in the previous year of 1,637 women are categorized: 34% desire/frequency (low sexual desire, desire discrepancy); 28.5% physical responsiveness (female arousal, orgasm; male partners' erectile difficulties, ejaculatory control); 16% lovemaking (sexual technique); 7.5% finding a partner; < 5% sexual relationship, fertility, pregnancy, STDs/safe sex, the woman's body/health, non-monogamy, orientation; 547 others reported none. Exemplary quotes from respondents are included. Sex therapy for low sexual desire is addressed. Recommended solutions emphasize individual differences and the multidimensionality of sexuality.     

Adult self-image and well-being after testicular cancer: The role of agency and meaning

Objective: Cancer during young adulthood can limit the extent to which one adopts an adult self-image. However, the relationship of adult self-image to cancer-related adjustment remains unexplored. The current study examines relationships of adult self-image and social/emotional well-being and job-related problems in young testicular cancer survivors. Factors thought to facilitate future-oriented goals (i.e. agency and meaning) are examined as intermediary processes.

Design: Testicular cancer survivors (N = 171) between the ages of 18 and 29 completed questionnaire measures of adult self-image, agency, sense of meaning and indicators of adjustment.

Main Outcome Measures: Social and emotional well-being were measured by the Functional Assessment of Cancer Therapy-General. Job problems were assessed using the EORTC’s testicular cancer supplement (EORTC QLQ-TC26).

Results: Path model results revealed direct associations of survivors’ adult self-image with social (β = .20, p < .05), but not emotional well-being (β = .14, p < .01). Both agency and meaning mediated the relationship of adult self-image and well-being indicators. Finally, the relationship between adult self-image and job problems was only significant for those who were employed or in school (β = ?.19, p < .05).

Outcomes: Assessment of adult self-image might be useful in identifying risk for poor adjustment. Interventions that target agency and meaning might facilitate developmental goals.     

Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes

Abstract

Background: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH?±?BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures.

Aims: To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined.

Methods: A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH?±?BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression.

Results: In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p?=?0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p?=?0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p?=?0.856), and reoperations (p?=?0.689).

Conclusion: Combining masculinizing mastectomy with TLH?±?BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes.     

Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

Objective: This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas. Design: Participants were 140 English or Spanish-speaking Latinas (M_age = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2).

Main Measures: Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2.

Results: Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (β_s range from ?.31 to ?.18, p_s < .01).

Conclusions: Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.     

Cancer survivors’ and partners’ key concerns and quality of life

Objective: Understanding the concerns of cancer survivors is essential for effective interventions. This study was designed to identify the primary concerns of dyads coping with cancer, how concerns differed by role and sex, and whether concerns expressed during counselling were associated with survivors’ psychosocial well-being and adjustment.

Design: Forty-three dyads with breast and prostate cancer (N = 86 participants) were enrolled in an interpersonal telephone counselling intervention. Audio recordings of 228 counselling sessions were transcribed and content analysed qualitatively to identify major themes and key concerns. A total of three 30-min sessions were coded for each study participant. Quantitative data and statistical analyses were used to predict changes in survivors’ quality of life.

Main Outcome Measures: Participants completed psychosocial well-being measures (depression, positive/negative affect, and relationship satisfaction), pre- and post-counselling.

Results: Survivors’ concerns focused on cancer- and treatment-related issues, whereas partners’ concerns centred on the well-being of their spouse/partner with cancer, and what they were doing to help their loved one cope with his/her illness. Key concerns for all consisted of relationship maintenance and communication issues. Further, discussion of these concerns was predictive of significant improvements in adjustment post-counselling for women with breast cancer.

Conclusion: Discussion of interpersonal concerns may play a more important role in the well-being of women, than men, coping with cancer.     

The relationship of sexual adjustment and related sexual behaviors and attitudes to marital adjustment

Abstract

This paper examines the extent of relationship between sexual adjustment and marital adjustment for 30 married couples followed for 3–6 months. Sexual adjustment was assessed by means of the LoPiccolo-Steger Sexual Interaction Inventory, and two other measures termed a Couple Interaction Scale (CI) and a Couple Compatibility Ratio (CCR). Marital adjustment was assessed by means of the Locke-Wallace Marital Adjustment Scale (L-W MAS) and a clinically-devised instrument based on the extent of support between the marital partners. The two marital adjustment instruments agreed closely. A high degree of association was obtained between most of the sexual adjustment measures and the two marital adjustment measures; using the most reliable of these measures, it is estimated that sexual adjustment contributed between 40 % and 55 % of the variance in marital adjustment. This association was not due to a specific stage of. the human sexual response cycle of desire, excitement, orgasm and gratification. Intercorrelation of measures of each of these stages with the marital adjustment measures generally yielded significant relationships.     

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.     

Theory of mind ability in high socially anxious individuals

Background/Objectives: Research has demonstrated an association between social anxiety and impaired Theory of Mind (ToM). We assess whether ToM deficits occur even at a subclinical level of social anxiety and whether group differences in ToM performance are consistent with interpretation bias. We also explore potential reasons as to why socially anxious individuals may perform differently on ToM tasks.

Methods/Design: Undergraduate participants high (HSA; n?=?78) and low (LSA; n?=?35) in social anxiety completed a task of ToM decoding, the Reading the Mind in the Eyes (MIE), a task of ToM reasoning, the Movie for the Assessment of Social Cognition (MASC), and a post-task questionnaire about their experience completing the MASC.

Results: HSAs performed marginally worse than LSAs on the MIE on neutrally valenced trials, and their pattern of errors may be consistent with a negative interpretation bias. HSAs and LSAs did not differ overall in performance on the MASC, though HSAs reported experiencing more confusion and distress than LSAs during the task, and this distress was associated with more MASC errors for HSA participants only. These results provide insight into the nature of ToM ability in socially anxious individuals and highlight important avenues for future research.     

An Israeli Sex Therapist Considers a New View of Women's Sexual Problems

Abstract

By focusing on the inequalities that exist between men and women as a result of culture, ethnicity, religion, legislation, etc., the New View of Women's Sexual Problems brings to the forefront the social inequalities that may produce sexual dysfunction in women in Israel. In addition, the rights to sexual information, comprehensive sexual education and appropriate sexual health care have not been recognized in Israel. The field of sexology in Israel is also relatively young and underdeveloped. Therefore, the New View of Women's Sexual Problems' focus is extremely relevant for sexologists and sex therapists working in Israel.