Experiencing menopause in the context of cancer: Women’s constructions of gendered subjectivities

Objective: Many women experience premature menopause following cancer treatment, accompanied by psychological distress, and poor health-related quality of life. In this qualitative study, we examined how women construct their gendered subjectivities – their sense of self as a woman – in the context of premature menopause after cancer.

Design: We analysed data from open-ended survey items and semi-structured interviews with women who had experienced cancer. Six hundred and ninety-five women completed the online survey and 61 took part in a semi-structured interview. A thematic decomposition was conducted to identify the subject positions associated with menopause taken up by the women.

Results: Three overall themes were identified: ‘The Incomplete Woman,’ ‘The Abject, Asexual Woman’ and ‘Out of Time and Social Isolation.’ Menopause was predominantly constructed as a negative experience, similar to older post-menopausal women and dissimilar to peers, contributing to experiences of social isolation. Menopause also signified the presence of a medically diagnosed cancer condition, and uncertainty around cancer prognosis.

Conclusion: It is important for cancer support group leaders and other service providers to be sensitive to women’s negotiation of menopause following cancer, in the context of broader cultural constructions, in order to provide appropriate information and support.     

The perceptions of the causes of cardiac diseases: a taxonomy

Objective: This study verifies whether the open-ended question of the B-IPQ can collect causal attributions of patients with cardiac diseases, define the more frequent causal attributions reported, classify them and describe the relation between the classification of the causes and patients’ characteristics.

Design: A group of 2011 patients with cardiac diseases was recruited during the first week of cardiac rehabilitation.

Primary outcome measures: Every participant filled in the B-IPQ and the HADS. The qualitative and quantitative analyses of the text using T-LAB identified the most frequent causal attributions and their co-occurrences.

Results: Among the patients, 26% did not recognise any causal attribution. The likelihood that the patients did not provide an answer was increased in older patients, females, patients with lower levels of education and higher levels of depression. Smoking and stress emerged as the most important attributions, followed by genetics, metabolic syndrome, work and nutrition. Four thematic clusters were identified: ‘work and stress’, ‘metabolic syndrome and hypertension’, ‘displeasures and body care’ and ‘heredity and other related diseases’.

Conclusions: This study suggests a classification of the causal attributions in patients with cardiac diseases and identifies thematic patterns and unknown attributions. The themes identified can serve as categories for future closed-ended questions.     

Interpersonally traumatised patients’ view of significant and corrective experiences in the psychotherapeutic relationship

Background: Clinical experience points to the importance of significant experiences in the therapy relationship for patients who have been interpersonally traumatised but the empirical research is limited.

Aim: The aim was to gain increased knowledge about how significant and potentially corrective experiences within the therapeutic relationship were described by patients in trauma-focused therapy and how the participants thought such experiences might have affected the therapeutic work.

Method: Five patients who were, or recently had been, in trauma-focused therapy were interviewed about their experiences of the therapy relationship. Thematic analysis was used to analyse the interviews.

Results: Four themes were identified: ‘Human contact’, ‘Validation’, ‘To face the painful’ and ‘Development of trust’. Positive experiences in the therapeutic relationship were sometimes seen as crucial for the therapeutic work and for patients’ improvement.

Conclusions: Previous findings about the significance of corrective experiences in psychotherapy were confirmed, particularly experiences of the therapist’s accepting stance, personal and human contact and encouragement. The therapist’s ability to evoke trust in the patient and her capacity to help patients to face painful material may be particularly important for traumatised patients.     

Psychic determinism: Leibniz and Freud

You ask me to say a number, any number, and I say ‘127’. Have I answered freely?

“Of course”, says Hume: no‐one compelled me—the fact that my choice was necessitated is irrelevant.

“Yes”, says Leibniz: my choice was not necessitated—the fact that it was determined ( = ‘inclined') is not enough to make it unfree.

“No”, says Freud: my choice was determined—the fact that it was not necessitated is not enough to make it free.

The paper examines the interplay between these answers.     

Sex,germs, and health: pathogen-avoidance motives and health-protective behaviour

Objective: Recent work suggests that the psychology of pathogen-avoidance has wide-reaching effects on how people interact with the world. These processes – part of what has been referred to as the behavioural immune system – are, in a way, our ‘evolved’ health psychology. However, scholars have scarcely investigated how the behavioural immune system relates to health-protective behaviours. The current research attempts to fill this gap.

Design: Across two cross-sectional studies (N = 386 and 470, respectively), we examined the relationship between pathogen-avoidance motives and health-protective behaviour.

Outcome Measures: The studies used self-reported measures of attitude and intention as indicators of health-protective behaviour.

Results: Data collected in Study 1 revealed that pathogen-avoidance motivation related to participants’ attitude and intention towards sexually transmitted infections screening. High levels of pathogen-avoidance motivation were also related to having had fewer sexual partners, which partially mediated the effect of pathogen-avoidance variables on testing motivation. Study 2 extended these findings by showing moderate associations between pathogen-avoidance motivation and a broad range of health-protective behaviours, including but not limited to pathogen-related health concerns.

Conclusion: We argue that understanding and targeting pathogen-avoidance psychology can add novel and important understanding of health-protective behaviour.     

Self-reported overeating and attributions for food intake

Objective: We examined whether people’s attributions for their eating behaviour differ according to whether they believe they have eaten more, less or about the same as they normally would.

Design: Participants were served a small or large portion of pasta for lunch. Afterwards, they were asked to compare how much they ate in the study to how much they normally eat for lunch, resulting in three intake-evaluation categories: ‘ate less’, ‘ate about the same’ or ‘ate more’.

Main outcome measures: How much participants ate; the extent to which they attributed their food intake to an internal cue (i.e. hunger) and an external cue (i.e. the amount of food served).

Results: Participants served a large portion ate more than those served a small portion, but the magnitude of the portion-size effect did not vary across intake-evaluation categories. Furthermore, although participants in all groups indicated that their hunger influenced how much they ate, only those in the ‘ate more’ group indicated that the amount of food available influenced how much they ate.

Conclusion: People appear to be willing to explain their food intake in terms of an external cue only when they believe that they have eaten more than they normally would.     

The Cohen–Hoberman inventory of physical symptoms: Factor structure,and preliminary tests of reliability and validity in the general population

Objective: The present study aimed to investigate the factor structure and psychometric properties of the Cohen–Hoberman inventory of physical symptoms (CHIPS). Construct and discriminant validity were examined by assessing associations between factors and subjective health complaints (SHC) inventory subscales in addition to measures of pain sensitivity, perceived stress and psychological distress.

Design: A cross-sectional online survey was conducted with 535 healthy individuals from the general population (80.6% female, mean age = 29.80).

Main outcome measures: Participants completed CHIPS, SHC, perceived stress scale, pain sensitivity questionnaire, and hospital anxiety and depression scale.

Results: Principal components analysis demonstrated that CHIPS comprised 8 ‘symptoms’ factors as follows; ‘sympathetic/cardiac’ (7 items; α = .827), ‘muscular’ (6 items; α = .752), ‘metabolic’ (5 items; α = .736), ‘gastrointestinal’ (5 items; α = .714), ‘vasovagal’ (4 items; α = .743), ‘cold/flu’ (2 items; α = .837), ‘headache’ (2 items; α = .690) and ‘minor haemorrhagic’ (2 items; α = .309). Significant correlations were observed between factors and SHC subscales (moderate-high), pain sensitivity (negligible-low) and levels of perceived stress and anxiety (low-moderate) indicating good construct, and discriminant validity, respectively.

Conclusions: CHIPS is a multidimensional and internally consistent measurement of physical symptoms. The postulated factor structure may be used for research purposes particularly in health psychology, to consistently differentiate between clusters of self-reported symptoms.     

Understanding behavioural clusters: Identifying differences between clusters of health behaviours on key constructs

Objective: To uncover the rationale underlying the perceived distinction between clusters of health behaviours by identifying cognitive constructs that differentiate among them, and creating a ‘cognitive profile’ for each behavioural cluster. Thus, different determinants and characteristics of health behaviours (e.g. ‘perceived behavioural control’, ‘impact on health’, ‘effort’, ‘non-health rewards’, ‘habit’) were used to compare health behaviour meta-clusters (physical and psychosocial) and clusters (e.g. nutrition behaviours, substance abuse, medical practices).

Methods: A sample of lay people (N = 1956) judged items representing behavioural clusters delineated in the Health Behaviour Taxonomy on 14 constructs.

Results: Significant differences emerged between the physical and psychosocial meta-clusters, as well as among their sub-clusters. For example, physical behaviours were higher on ‘perceived behavioural control’ and ‘impact on health’ compared to psychosocial behaviours, and nutrition was perceived highest on ‘effort’ and ‘non-health rewards’ compared to the other clusters of the physical meta-cluster.

Conclusion: The findings increase our understanding of the logic underlying lay people’s cognitive schema of health behaviour clusters. ‘Cognitive profiles’ that explain differences between the clusters were identified, which can be used to design health messages and interventions targeting multiple health behaviours.     

Bloor's bluff: Behaviourism and the strong programme

The accumulated case studies in the Sociology of Scientific Knowledge have been taken to establish the Strong Programme's thesis that beliefs have social causes in contradistinction to psychological ones. This externalism is essentially a commitment to the stimulus control of behaviour which was the principal tenet of orthodox Skinnerian Behaviorism. Offered as ‘straight forward scientific hypotheses’ these claims of social determination are asserted to be ‘beyond dispute’.

However, the causes of beliefs and especially their contents has also been the subject of intense study in the quite different domain of cognitive science where internal states, images, rules, representations and schemas are postulated as explanatory constructs. Such explanations which postulate mental states are described by Bloor as infected by the ‘disease’ of ‘psychologism’ and Bloor has defined his Strong Programme in terms of its diametrical opposition to mentalistic theories. For example, Bloor has explicitly endorsed the Behaviourist rejection of mental representations such as images. Accordingly, a direct comparison of these radically divergent approaches to a common subject matter is of considerable interest.

The paper attempts to reveal the unnoticed enormity and recidivism of the sociological programme, and how its vulnerability is betrayed in Bloor's response to criticism on central issues.     

‘It was all intertwined’: Illness representations and self-management in patients with cancer and anxiety/depression

Objective: Cancer and anxiety/depression frequently co-occur, leading to poorer outcomes for these illnesses. However, the majority of existing research investigates how participants view single illnesses alone. This study aimed to explore the content of individuals’ multimorbid representations and how these relate to their coping behaviours and self-management strategies for cancer and anxiety/depression.

Design: A semi-structured qualitative research design with theoretical thematic analysis.

Main Outcome Measures: Multimorbid illness representations, coping behaviours, and self-management strategies.

Results: In interviews with 21 participants multimorbid representations varied, three participants viewed cancer and anxiety/depression as unrelated, five participants were uncertain about the relationship between cancer and anxiety/depression, and the majority of participants perceived cancer and anxiety/depression as related. This third group of participants often described relationships as causal, with representations having both positive and negative influences on coping behaviours and self-management strategies. Representations were shown to change over the course of the cancer experience, with fear of cancer recurrence and the influence of participants’ most challenging illness also discussed.

Conclusions: People hold multimorbid illness representations that can influence self-management. An awareness of these representations by researchers, health professionals, and patients is important for the creation of future interventions that aim to improve and maintain patient wellbeing.     

Broken mirror: The intertwining of therapist and client stories of childhood sexual abuse (CSA)

In recent years, there has been a great deal of attention given to the potential increased risk of vicarious traumatisation (VT) for clinicians with a history of childhood sexual abuse.

I am curious about whether the silencing, which has been ubiquitous within society, is also prevalent within the therapeutic profession. I wonder if therapists with a history of abuse feel they have to bracket their experience, and if this limits the potential for positive transformation.

In this paper, I draw upon my narrative study of therapists with a history of abuse. The methodology followed was narrative inquiry with two therapists in addition to an autoethnography. I used ‘narrative analysis’ to analyse the data. The findings of the study covered themes of transgenerational trauma, ‘the wounded healer’, caregivers’ responsibility in communal cultures and dissociation.

In this paper, I will consider the part dissociation plays when there is a shared history of trauma, and the ways in which dissociative enactments within the consulting room themselves may be part of the mutual healing. For this paper, only extracts from interviews with one of my participants will be included.     

The mediating and moderating role of planning on mothers’ decisions for early childhood dietary behaviours

Objective: Examine the roles of action and coping planning on the intention–behaviour relationship for mothers’ decisions for their young children’s dietary behaviours.

Design: Prospective design with two waves of data collection, one week apart.

Main outcome measures: Mothers (N = 197, M_age = 34.39, SD = 5.65) of children aged 2–3 years completed a main questionnaire assessing planning constructs and intentions, and a one-week follow-up of the target behaviours – ‘healthy eating’ and ‘discretionary choices’.

Results: Intention was the strongest predictor of behaviour for both dietary behaviours. For healthy eating, intention moderated the indirect relationship between intention–behaviour via planning; coping planning was less important when intention was strong. Further, intention was not a direct predictor of behaviour when intention was relatively low. Action planning was not a direct predictor of either behaviour after accounting for intention and coping planning; action planning on behaviour was mediated by coping planning (only for healthy eating). Intention was not a direct predictor of coping planning; intention on coping planning was mediated by action planning. Neither type of planning predicted discretionary choices.

Conclusion: Current findings contribute novel information on the mechanisms underpinning the effect of action and coping planning on the intention–behaviour relationship.     

Predicting jet lag in long-haul cabin crew: The role of illness cognitions and behaviour

Objective: Established risk factors for jet lag are mostly physiological including circadian preference, age, gender, the number of flight zones crossed and to some extent direction of travel. Some research has also highlighted a role for psychosocial factors including sleep, diet and ‘circadian’ health behaviours and illness cognitions although this remains relatively untested. The aim of this study was to evaluate the role of sleep, diet and illness cognitions in predicting perceived jet lag amongst long-haul crew.

Design: Sixty long-haul crew took part in a longitudinal study. Profile characteristics (including chronotype), preparation strategies (sleep, eating and ‘circadian’ behaviours) and illness cognitions were measured at baseline (before a trip).

Main outcome measures: Subjective jet lag (unidimensional and multidimensional) was measured on the crews’ second day off (post-trip).

Results: Hierarchical regression analyses showed that unidimensional jet lag was predicted by the belief in a cyclical timeline, whereas multidimensional jet lag was predicted by multidimensional jet lag at baseline and to a lesser extent by identity. No role was found for profile characteristics and preparation strategies.

Conclusion: Illness cognitions partly explain the experience of perceived jet lag in long-haul cabin crew indicating that jet lag is in part a psycho-social construct, not just a biological one.     

A qualitative study exploring the experience of people with IBD and elevated symptoms of anxiety and low mood and the type of psychological help they would like

Background: People with inflammatory bowel disease (IBD) are at increased risk of developing anxiety and low mood. We sought to explore the experience of people with IBD and moderate–severe symptoms of anxiety/low mood to identify psychological processes which could be targeted in psychological interventions, as well as the kind of psychological support preferred.

Methods: Twenty-five participants with IBD and moderate–severe symptoms of anxiety/low mood were recruited for interview. Template analysis was utilised to analyse interview data. We explored the situations, cognitions and behaviour linked to symptoms of anxiety and low mood by people with IBD, as well as the kind of psychological help preferred.

Results: Two themes were identified within participants accounts of symptoms of anxiety; ‘under performance’ and ‘preventing an accident’. Two further themes were identified for symptoms of low mood; ‘lack of understanding’ and ‘stigma’. Expertise and understanding was the main theme identified for the type of psychological help desired.

Conclusion: The analysis highlights situations, cognitions and behaviour linked to anxiety and low mood by people with IBD and the type of psychological support desired. Our findings link to the knowledge and competencies set for psychological therapist working with long-term conditions.     

Working mechanisms of a web-based self-management intervention for cancer survivors: a randomised controlled trial

Objective: The aim of this study was to investigate whether problem-solving skills and perceived personal control over cancer recovery mediated the intervention effects on depression and fatigue of a web-based computer-tailored intervention for cancer survivors – the Kanker Nazorg Wijzer (Cancer Aftercare Guide).

Design: Patients were recruited through 21 Dutch hospitals (November 2013–June 2014). The mediation model was tested in a randomised controlled trial with an intervention group (n = 231) and a waiting list control group (n = 231).

Main outcome measures: Hypothesised mediators problem-solving skills (SPSI-R) and personal control (IPQ-R) were measured at baseline and 3 months from baseline. Outcomes depression (HADS) and fatigue (CIS) were measured at baseline and 6 months from baseline.

Results: The intervention effects in decreasing depression and fatigue were mediated by personal control. Problem-solving skills did not mediate the intervention effects on depression and fatigue.

Conclusion: While personal control in the control group decreased in the first three months after baseline, levels of personal control within the intervention group were maintained. This effect partially explained the intervention effects on depression and fatigue. The results provide evidence for the relevance of addressing personal control in web-based interventions in order to improve psychosocial well-being in early cancer survivors.     

Negotiating faith and identity in Muslim–Christian marriages in Britain

Marriage between Muslim men and Christian or Jewish women has been a recognized though controversial phenomenon through Islamic history. Qur'anic permission is given (Q 5:5) but the normative condition in Shari^ca is that Islam should predominate over another faith, particularly in the identification of children.

In Britain and other Western countries the prevailing cultural and legal context of autonomy in relationship formation and choice of marriage partner means that Muslim–Christian marriages may happen without conformity to religious rules or familial preference, for example in the case of Muslim women marrying non-Muslim men. Nevertheless, amongst those surveyed, Muslim identification remained strong even where marriages were deemed transgressive.

Amongst Christian partners, faith identification (of parents and children) was more likely to be treated as autonomous and personally negotiable in the context of marriage.

The experience of hybridity and liminality in these marriages may influence attitudes to faith itself and there was evidence of both ‘universalizing’ and ‘particularist’ faith responses amongst couples.     

Coping strategies of former prisoners of war mediate the intergenerational transmission of posttraumatic stress symptoms

Objectives: Certain coping strategies, characterized by emotional coping or disengagement/ avoidance, have been linked to posttraumatic stress disorder (PTSD) and PTSD symptoms (PTSS). However, the role of primary trauma victims’ coping strategies in the intergenerational transmission of PTSS is still lacking. This prospective study assessed the mediating role of former prisoners of war’s (ex-POWs) coping strategies in the associations between ex-POWs’ PTSS and their adult offspring’s secondary PTSS in relation to their fathers’ captivity and psychiatric symptomatology.

Design: A correlational, prospective study.

Method: A sample from the 1973 Yom Kippur War composed of 79 Israeli ex-POW father-offspring dyads completed self-report measures. Fathers were assessed in 2001 and 2008, and their adult offspring participated in 2014.

Results: ex-POWs’ problem-focused coping strategies of active coping and planning, as well as disengagement-oriented coping strategies of alcohol and substance use and venting of emotions, were negatively associated with offspring’s PTSS and psychiatric symptomatology. Importantly, ex-POWs’ venting of emotions mediated the link between ex-POWs’ PTSS and their offspring’s secondary PTSS.

Conclusions: Ex-POWs with PTSS might expose their offspring to dysregulated mood, behaviors, and cognitions. Special awareness should be given to the venting of emotions coping style as possible mechanism for the intergenerational transmission of captivity-related PTSS.     

Couple adjustment to a stressful life event: a dyadic investigation of the roles of positive reframing and perceived benefits

Background and Objectives: This study examines positive reframing (a form of meaning making), perceived benefits (a form of meanings made) and adjustment in couples who experienced a stressful life event in the past year. This study tested whether couple members’ scores were nonindependent and whether one’s own perceived benefits was predicted by their own positive reframing (actor effect) as well as their partner’s positive reframing (partner effect). Further, this study tested actor and partner effects for the link between perceived benefits and adjustment and whether positive reframing (the initial variable) works through perceived benefits (the mediator) to affect adjustment (the outcome) at the dyadic level.

Design: A standard dyadic design was used.

Methods: Eighty couples completed measures of positive reframing, perceived benefits, and adjustment (depression, anxiety, positive affect, life satisfaction, and relationship satisfaction).

Results: Partners’ scores on study variables were related, and although only actor effects were found for the path between positive reframing and perceived benefits, both actor and partner effects were found for the path between perceived benefits and adjustment. Mediation was found for actor–actor and actor-partner indirect effects.

Conclusions: Results indicate that a greater focus on interpersonal factors is needed to further meaning-making theory and inform practice.     

The systematic identification of content and delivery style of an exercise intervention

Objective: This study explored the utility of using behaviour change taxonomies and checklists to systematically assess the content and delivery of behavioural support for physical activity delivered through an established exercise-referral scheme.

Design: An observation study was conducted whereby 22% of initial consultations were observed and audio-recorded, using quota sampling stratified by exercise-referral advisor.

Main outcome measures: Content was independently coded by two researchers, to assess; (i) completeness in delivering the programme protocol, (ii) behaviour change techniques delivered (defined using the CALO-RE taxonomy) and (iii) delivery style according to the Behaviour Change Counselling Index (BECCI).

Results: Protocol completeness was 63.6% (range 35.6–74.6%). The behaviour change techniques delivered most consistently were ‘providing information about where and when to perform the behavior’ (86%) and ‘setting outcome goals’ (82%). Other evidence-based techniques such as self-monitoring were infrequently observed. Variation in BECCI scores indicated that advisors could, but did not consistently, provide a client-centred service.

Conclusion: This study highlights how theoretically informed taxonomies can be useful in evaluating service delivery within applied practice, providing a meaningful way of assessing the completeness of protocol delivery relative to evidence. The provision of feedback to practitioners based on such objective criteria also facilitated positive academic-practitioner communication.