Manifestations of anxiety and coping strategies in patients with metastatic lung cancer and their family caregivers: a qualitative study

Objective: Advanced non-small cell lung cancer (NSCLC) is common, deadly, and associated with impairing anxiety for patients and caregivers who often co-experience similar symptoms that can vary together over time. We aimed to discover themes as to how NSCLC patients and caregivers express and cope with anxiety.

Design: Semi-structured interviews of patient-caregiver dyads (N?=?21), coded using NVivo Software.

Main Outcome Measures: Open-ended questions on anxiety mutuality, giving or receiving care, communication, and the most difficult aspects of having or caring for someone with Stage IV NSCLC.

Results: Analyses revealed that patients and caregivers were linked psychologically, co-experiencing symptoms of distress or coping, rising and falling together. Shared patient and caregiver themes emerged of cognitive, behavioural and physiological manifestations of anxiety and coping mechanisms.

Conclusions: Patient and caregiver expressions of anxiety and coping methods mapped onto the cognitive-behavioural model, implying potential use of cognitive behavioural therapy (CBT) to address these issues. This expands understanding of symptoms and coping strategies in NSCLC, explores patient-caregiver interaction, and confirms the need for future clinical intervention. Future research should focus on development and dissemination of CBT-based dyadic interventions addressing anxiety in NSCLC patients and caregivers.     

Development and initial validation of the job loss grief scale

Background: Research on complicated grief (CG) symptoms following job loss is surprisingly rare. Involuntary job loss can turn someone’s world upside down and can result in loss of identity, social contacts, and self-worth. In this study, we drew on the literature on major life events in conceptualizing involuntary job loss as a significant and potentially devastating life event.

Objectives: The aim of this study was to develop and evaluate an instrument that measures job loss-related CG symptoms, the Job Loss Grief Scale (JLGS). The purpose of the JLGS is to foster systematic research on CG symptoms following job loss.

Design: A cross-sectional study

Methods: We recruited Dutch workers who had lost their job, 130 men and 158 women with an average age of 49.6 years. To examine the psychometric properties of the JLGS and its associations with other concepts we conducted correlational and confirmatory factor analyses.

Results: CFA revealed that the JLGS was a one-dimensional instrument, and that CG symptoms were distinguishable from depression and anxiety symptoms.

Conclusion: The JLGS is a reliable and valid instrument to measure job loss-related CG symptoms. The availability of the JLGS could stimulate systematic research on the antecedents and consequences of involuntary job loss.     

Sleep quality and treatment of social anxiety disorder

Background and Objectives: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may affect treatment outcome. We examined whether: (1) individuals with SAD differed from healthy controls (HCs) in sleep quality, (2) baseline sleep quality moderated the effects of treatment (Cognitive–behavioral group therapy [CBGT] vs. mindfulness-based stress reduction [MBSR] vs. waitlist [WL]) on social anxiety, (3) sleep quality changed over treatment, and (4) changes in sleep quality predicted anxiety 12-months post-treatment.

Design: Participants were 108 adults with SAD from a randomized controlled trial of CBGT vs. MBSR vs. WL and 38 HCs.

Methods: SAD and sleep quality were assessed pre-treatment and post-treatment; SAD was assessed again 12-months post-treatment.

Results: Participants with SAD reported poorer sleep quality than HCs. The effect of treatment condition on post-treatment social anxiety did not differ as a function of baseline sleep quality. Sleep quality improved in MBSR, significantly more than WL, but not CBGT. Sleep quality change from pre- to post-treatment in CBGT or MBSR did not predict later social anxiety.

Conclusions: MBSR, and not CBGT, improved sleep quality among participants. Other results were inconsistent with prior research; possible explanations, limitations, and implications for future research are discussed. ClinicalTrials.gov identifier: NCT02036658.     

Cultural evidence for interpretation bias as a feature of social anxiety in Chinese adolescents

Background and Objectives: Interpretation bias (IB), defined as the tendency to interpret ambiguous social situations in a threatening manner, has increasingly been studied in children and adolescents. Compared to Western samples, the relation between IB and social anxiety in Chinese youth has received little attention. The present study was to mainly examine the relationship between IB and social anxiety among Chinese adolescents.

Design: Cross-sectional design was utilized.

Methods: IB, measured by the Adolescents’ Interpretation Bias Questionnaire (AIBQ), and social anxiety were surveyed among a group of high socially anxious Chinese adolescents (n?=?25) and a control group (n?=?29). Participants were asked to rate the likelihood of interpretations coming to mind in social/non-social situations and to choose the most believable interpretation.

Results: The high social anxiety group had more negative interpretations and beliefs in social situations, and the interpretation bias was particular to social anxiety versus depression. Additionally, the cognitive content-specificity hypothesis was supported; the high anxious group showed interpretation bias in social situations, but didn’t have more negative interpretations of non-social situations, after controlling for depression.

Conclusions: The present study yielded comparable findings as found in Western samples regarding the relation between IB and social anxiety.     

Attentional disengagement from negative natural sounds for high-anxious individuals

Background and objectives: Previous studies have not consistently concluded whether high-anxious persons exhibit attentional bias towards negative natural auditory stimuli. The present study explores whether auditory negative stimuli could induce attentional bias to negative sounds in real life and investigates the exact nature of these biases using an emotional spatial cueing task.

Design: Experimental study with a mixed factorial design.

Method: We created two groups according to the state-trait anxiety scale, namely high and low trait anxiety. Participants (N?=?68 undergraduate students) were required to respond to an auditory target after receiving a negative (aversive sounds from natural life) or neutral auditory stimuli.

Results: A 2 (Validity: valid/invalid)?×?2 (Cue Valence: negative/neutral)?×?2 (Anxiety Group: LA/HA) repeated-measures ANOVA on reaction times revealed that participants with high trait anxiety exhibited slower reaction times in invalid trials following negative cues than following neutral cues. Higher levels of trait anxiety were associated with more difficult attentional disengagement from negative auditory information.

Conclusions: The results demonstrate that impaired attentional disengagement was one of the mechanisms by which high-anxious participants exhibited auditory attentional bias to natural negative information.     

No pain,no gain: cross-lagged analyses of posttraumatic growth and anxiety,depression, posttraumatic stress and prolonged grief symptoms after loss

Background and objectives: Major negative life-events including bereavement can precipitate perceived positive life-changes, termed posttraumatic growth (PTG). While traditionally considered an adaptive phenomenon, it has been suggested that PTG represents a maladaptive coping response similar to cognitive avoidance. To clarify the function of PTG, it is crucial to establish concurrent and longitudinal associations of PTG with post-event mental health problems. Yet, longitudinal studies on this topic are scarce. The present study fills this gap in knowledge.

Design: A two-wave longitudinal survey was conducted.

Methods: Four-hundred and twelve bereaved adults (87.6% women) filled out scales assessing PTG and symptoms of depression, anxiety, prolonged grief, and posttraumatic stress at baseline and 6 months later.

Results: The baseline concurrent relationships between all symptom levels and PTG were curvilinear (inverted U-shape). Cross-lagged analyses demonstrated that symptom levels did not predict levels of PTG 6 months later, or vice versa.

Conclusions: Findings suggest PTG after loss has no substantive negative or positive effects on mental health. Development of specific treatments to increase PTG after bereavement therefore appears premature.     

Confirmatory factor analysis of the post-event processing inventory in a community sample seeking self-help for social anxiety

Background: Post-event processing (PEP) refers to negative rumination following anxiety-inducing social situations. The Post-Event Processing Inventory (PEPI; Blackie & Kocovski, 2017, Development and validation of the trait and state versions of the post-event processing inventory. Anxiety, Stress, & Coping, 30, 202–218.) consists of both trait and state forms. Although the psychometric properties of the PEPI have been very good in past research, the factor structure of the scale was examined with student samples only.

Objectives: The primary purpose of the present study was to confirm the factor structure of the PEPI with a sample of individuals seeking self-help for social anxiety and shyness.

Design and Method: Individuals interested in receiving self-help (N?=?155) completed a battery of questionnaires, including the trait and state forms of the PEPI.

Results: On each version of the scale, we confirmed that a second-order factor (global PEP) could be inferred from three first-order factors (frequency, intensity, and self-judgment).

Conclusions: The hierarchical factor structure of the PEPI in the present study is consistent with previous research. The findings from the present study illustrate the utility of the PEPI amongst a community sample of individuals seeking self-help for social anxiety.     

Sources of stress and worry in the development of stress-related mental health problems: A longitudinal investigation from early- to mid-adolescence

Background and Objectives: Stress and stress-related mental health complaints are common and increasing among adolescents, especially girls. Identifying typical sources of stress as well as central intervention targets is an important effort in the development of effective prevention and treatment protocols. This study investigated worry as potential mediator in the development of mental health problems in response to common stressors in adolescence. We also examined to what sources adolescents ascribe their stress over the years from the 7th through the 9th grade.

Design: Prospective cohort study.

Methods: Self-reported subjective stressor load, worry, anxiety and depressive symptoms were assessed in a sample of Swedish 7th graders (N?=?1137; 46% girls, mean age 13.2) with follow-up assessments one and two years later.

Results: School was the most common source of stress across all time-points, with girls reporting considerable more stress than boys. Worry mediated the relationship between overall stressor load and depressive symptoms and anxiety over time and was not moderated by gender.

Conclusions: Worry may be an important target in stress prevention and efforts to prevent stress-related problems would benefit from focusing on early adolescence as especially school stress is already relatively common in grade 7.     

The relation between goal adjustment,goal disturbance,and mental well-being among persons with multiple sclerosis

Objective: This study investigated the role of goal adjustment, i.e. disengaging from blocked goals and reengaging into alternative goals, in mental well-being and goal disturbance in persons with multiple sclerosis (MS).

Design: A cross-sectional design was used with self-report data from questionnaires and Personal Project Analysis (PPA).

Main outcome measures: Dependent variables were mental well-being, indicated by depression/anxiety (HADS; Hospital Anxiety and Depression Scale) and mental functioning (SF-36; Short Form Health Survey), and goal disturbance, indicated by goal manageability and goal interference (PPA). Independent variables were patient-reported physical impairment (SF-36) and goal disengagement and reengagement (GAS; Goal Adjustment Scale).

Results: Higher goal reengagement was associated with better mental well-being, but unrelated to goal disturbance. Goal disengagement only showed a negative association with anxiety. High disengagement was associated with lower goal interference but only for those also scoring high on reengagement. Goal adjustment did not buffer the effects of physical impairment on mental well-being and goal disturbance. Contrary to expectations, higher goal reengagement increased the association between physical impairment and goal interference.

Conclusion: Although goal reengagement is associated with better mental well-being in persons with MS, it might also strengthen the perceived effect of physical impairment on goal interference.     

Should we suppress or reappraise our stress?: the moderating role of reappraisal on cortisol reactivity and recovery in healthy adults

Background: People differ in their ability to regulate their physiological stress response. Individual differences in emotion regulation strategies such as suppression and reappraisal may explain this differential response to stress.

Objective: The aim of the current study was to assess whether daily use of suppression and reappraisal as well as their interaction predicted physiological stress reactivity and/or recovery, as assessed by variations in cortisol levels.

Method: Thirty-eight healthy young adults (13 men) completed the Emotion Regulation Questionnaire and were exposed to a psychosocial stressor, throughout which salivary cortisol was measured.

Results: Linear regressions showed main effects of reappraisal and suppression on cortisol reactivity and a main effect of suppression on cortisol recovery, where both strategies were positively associated with stress phases. Moreover, results showed a significant interaction of suppression by reappraisal in predicting both cortisol reactivity and recovery. Simple slope tests revealed that reappraisal moderated the association between suppression and both phases of cortisol responsivity.

Conclusion: Our results suggest that reappraisal represents a protective factor against the deleterious effects of suppression on stress responsivity. This study underlines the importance of investigating emotion regulation strategies as a means to understand individual differences in vulnerability to stress-related psychopathologies such as anxiety and depression.     

Stress experience and performance during an oral exam: the role of self-efficacy,threat appraisals,anxiety, and cortisol

Background and Objectives: High self-efficacy may reduce emotional and physiological stress responses in the context of an examination. The present study investigated how these stress responses develop on an exam day, and sequential indirect effects between self-efficacy, threat appraisals, stress responses and performance.

Design and Methods: The sample comprised 92 students (46 women). Self-efficacy, threat appraisals and state anxiety were assessed on a control day one week before an oral exam. Additionally, anxiety was assessed three times on the exam day. Salivary cortisol samples were collected at all time points.

Results: Pre-exam anxiety and cortisol decreased until grades were announced. For both responses, greater levels were related to a steeper decline. However, changes in anxiety and cortisol were unrelated. Self-efficacy was negatively related to threat appraisals and anxiety on the control day. Greater threat appraisals were associated with higher pre-exam anxiety and a steeper anxiety decrease on the exam day, which in turn, was related to better performance.

Conclusions: High levels of self-efficacy may reduce threat appraisals and anxiety in the lead up to an exam, which are related to the intensity and decline of anxiety on the exam day. A steeper decline of anxiety may be beneficial to performance.     

Doctors as patients: How psychological therapists experience the opposing ideologies

Research suggests that doctors experience higher levels of stress and mental health problems than the general population. Doctors frequently experience difficulty seeking help, and also challenges during psychological treatment, due to role reversal and competing ideologies.

Focusing specifically on the under-researched area of doctors as patients in a psychological context, this paper explores the processes underlying role transition as well as the therapeutic relationship that follows.

Furthermore, therapeutic reactions and adaptions of practice to this dynamic is also explored. A qualitative approach was employed and seven psychological therapists who had worked extensively with doctors as their patients were interviewed.

Subsequent interview data were thematically analyzed.

Six themes were generated: fear and pressure; status and control; variation of ideologies; change in practice; temporal changes; and help seeking and support.

The main barrier to recovery for doctors is difficulty in accessing services owing to the high-levels of stigma and shame that may be experienced. This research identifies some of the adaptions made by psychological therapists within their practice when working with doctors as patients.     

Autonomy deficits as vulnerability for anxiety: evidence from two laboratory-based studies

Background: Autonomous individuals are characterized by self-governance; awareness of and capacity to realize one’s wishes and needs, while being connected with and sensitive towards others. In line with earlier research showing consistent associations between autonomy-connectedness deficits and anxiety, we tested in two studies whether autonomy deficits predict anxious responses to acute stressors.

Methods: In Study 1, participants (N?=?177) viewed an anxiety-inducing film fragment and reported anxiety before and after viewing the clip. In experimental Study 2, participants (N?=?100) were randomly allocated to one of two conditions: giving a short presentation to an audience (impromptu speech task) or watching another person’s presentation (control condition). Anxiety was measured at baseline, after a preparation period and directly after the presentation.

Results: In Study 1, individuals’ anxiety in reaction to watching the movie was positively associated with the autonomy-connectedness component sensitivity to others. In Study 2, individuals’ anxiety in reaction to preparing the presentation was negatively associated with the autonomy-connectedness component self-awareness.

Conclusions: Specific autonomy components may be related to experiencing anxiety in differing situations (i.e., related to others’ distress or presenting one’s personal views). Collectively these results indicate that autonomy-connectedness deficits may form a vulnerability factor for experiencing anxiety.     

Perfectionism and beliefs about emotions in adolescents with chronic fatigue syndrome and their parents: a preliminary investigation in a case control study nested within a cohort

Objectives: To investigate perfectionism and beliefs about emotions in adolescents with chronic fatigue syndrome (CFS) and their parents.

Design: Case-control comparing adolescents (age 11–18) with CFS (N?=?121), asthma (N?=?27) and healthy controls (N?=?78) with a 3-month follow up for CFS participants.

Main outcome measures: Adolescents: Chalder Fatigue Questionnaire, physical functioning, Beliefs about Emotions scale (BES), Child and Adolescent Perfectionism Scale, Frost Multidimensional Perfectionism Scale (FMPS). Parents: BES, FMPS, Self—sacrificing scale, Affective styles questionnaire.

Results: Adolescents with CFS did not consistently report higher levels of perfectionism and unhelpful beliefs about emotions than adolescents with asthma or healthy adolescents. Mothers’ and adolescents’ beliefs about emotions and unhelpful perfectionism were significantly associated (p = .007). Linear regression found that neither adolescent perfectionism nor beliefs about emotions accounted for variance in subsequent fatigue or physical functioning.

Conclusion: Parental perfectionism and emotion regulation style may contribute to perfectionism in adolescents with CFS. Parental representations could contribute to fatigue maintenance.     

Traumatic stress symptoms following a lower limb amputation in diabetic patients: a longitudinal study

Objective: Limited research has focussed on the development of traumatic stress symptoms following an amputation due to a chronic disease such as Diabetes. This study analysed whether coping strategies, anxiety and depression symptoms, sociodemographic and clinical variables were related to traumatic stress symptoms in a sample of patients who had undergone a lower limb amputation.

Design: A longitudinal design with three assessments, one month (T1), six (T2) and ten months after an amputation surgery (T3), included 144 patients.

Main outcome measures: IES-R, WOC and HADS.

Results: Traumatic stress symptoms were prevalent at T1 (M?=?15.65, SD?=?15.40) and probable PTSD was observed in 13.9% patients. Presence of pain, high level of anxiety symptoms and emotion-focused strategies contributed to traumatic stress symptoms, and the period between T1 and T2, was critical. Six to ten months (Λ?=?0.871, F (2,84) =6.245, p=. 003), after surgery, symptoms tended to decrease 0.122 units (SE?=?0.032, p?=?0.002) per assessment.

Conclusions: Findings raise awareness to the need of urgent identification of traumatic stress symptoms in medically ill patients who underwent a lower limb amputation, given the prevalence of traumatic stress symptoms right after surgery and in the following six months.     

Distraction and reappraisal efficiency on immediate negative emotional responses: role of trait anxiety

Background and Objectives: Emotion regulation involves attempts to influence emotion unfolding and may target experiential, expressive and physiological responses. Several strategies can be used, such as reappraisal (re-evaluating the emotional situation to reduce its emotional meaning) or distraction (turning the attention toward non-emotional aspects of the situation). Previous research on these regulation strategies produced contrasting results regarding their efficiency and we hypothesize that this could be due to individual differences such as trait anxiety.

Design and Methods: Participants (N?=?77) were confronted with negative pictures and we examined the differential emotional reactivity according to trait anxiety, followed by a comparison of the efficiency of reappraisal and distraction in reducing emotional responses.

Results: Results show that trait anxiety has no impact on reactivity at the experiential and expressive levels, but has an impact at the physiological level, where high anxiety individuals show increased cardiac orienting effect, as well as higher skin conductance and respiratory rate. Regarding regulation, reappraisal and distraction successfully reduce emotional experience and expressivity, but not physiological arousal.

Conclusions: Such contrasting results involve that high trait anxiety individuals might benefit from the use of other kinds of strategies than reappraisal and distraction, some that may successfully target physiological responses.     

Perceiving college peers’ alcohol consumption: temporal patterns and individual differences in overestimation

Objective: This study examines temporal patterns and individual differences of overestimation in alcohol norm perception within a social network.

Design: Hundred psychology freshmen indicated biweekly during their first semester the drinks they consumed, the perceived average of their peers’ consumption, and with whom they were acquainted. At baseline, trait self-control was assessed.

Main outcome: The moderation of alcohol consumption overestimation by time and individual characteristics was explored.

Results: Results show that students overestimated alcohol consumption of their acquainted peers by 1.22 drinks (p?<?.001). For time periods at which peers reported high consumption, overestimation decreased. Additionally, individuals reporting high alcohol consumption (b?=??0.25, p?<?.001) and low self-control (b?=?0.27, p?=?.010) showed higher overestimation.

Conclusions: Students overestimate the alcohol consumption of peers not fully accounting for changes in peer-reports. Furthermore, individual differences suggest informational and motivational processes underlying overestimation.     

A meta-analysis of the association between forgiveness of others and physical health

Objective: This meta-analysis tested the relation between forgiveness of others and physical health (PH) with age, gender, race, education level, employment status, sample type, research design, type of PH variables, and publication status as the potential moderators.

Design: Eligible studies had participants with or without physical or mental health problems and had quantitative data on forgiveness of others and PH. The random-effects model was used to aggregate Fisher’s z effect sizes, which were converted back to correlation coefficients.

Main Outcome Measures: State forgiveness (forgiving an offense or offender) measures, trait forgiveness (a disposition to forgive) measures and physical health measures were included in the meta-analysis.

Results: A hundred and twenty-eight studies (N?=?58,531) were retrieved, in which the mean effect sizes showed a significant positive relationship between forgiveness of others and PH (r?=?0.14, p?<?0.001, 95% CI [0.11, 0.17]). Further, no moderators showed a significant relation between forgiveness of others and PH.

Conclusions: The positive relation between forgiveness of others and PH was not affected by potential moderators. Because the results are correlational, more forgiveness interventions may be needed to examine the causal effect of the relation between forgiveness of others and PH.