Psychological adjustment of children in the pretransplant phase of bone marrow transplantation: Relationships with parent distress,parent stress,and child coping

Families of 22 children preparing to undergo bone marrow transplantation (BMT) provided information concerning parent-reported major negative life stress, child coping strategies, parental psychological symptomatology, and child adjustment. Immediately prior to BMT, children and families are confronted with multiple stresses which challenge the child's coping and strain the parents' ability to assist the child with coping. Hence, stress, parental adjustment (distress), and child coping may be important factors affecting the child's overall psychological adjustment. Results showed that 15–25% of children and parents experienced clinically significant levels of psychological distress. Parent and child psychological distress were closely related. Major negative life stresses experienced by the parent and use of avoidant coping by the child significantly predicted child adjustment problems in the pretransplant period. Coping skills interventions targeting avoidant coping and management of parental stress/distress may reduce child psychosocial risk prior to BMT.     

The Adaptation of Patients During the Hospitalization Period of Bone Marrow Transplantation

A longitudinally study was conducted among 42 bone marrow transplantation (BMT) patients to investigate the association between pretransplant psychosocial variables and psychophysiological outcomes during the immediate convalescence period. Family relationships (cohesion, expressiveness, and conflict) and coping resources (cognitive, social, emotional, spiritual/philosophical, and physical resources) were assessed on the admission day (Day –7 Time 1). Data on psychological distress and pain intensity were obtained on Day +7 (Time 2) and Day +14 (Time 3). The average scores at Times 2 and 3 were computed to indicate the overall adjustments of the patients during the hospitalization period after the day of actual transplant (Day 0). It was shown that higher expressiveness family relationships and higher resources to cope effectively with stressful situations were associated with less psychological distress during the above period. Both pretransplant psychosocial variables were not associated with pain intensity during hospitalization. Allogeneic transplant patients reported higher pain intensity than did autologous transplant patients. Psychological distress and pain intensity were positively correlated with each other. Our findings show that pretransplant family relationships and coping resources associate moderately with psychological distress during the immediate convalescent period of BMT. The present findings support the family-centered approach to BMT care and provide a scientific basis for pretransplant psychosocial interventions.     

Predictors of posttraumatic growth following bone marrow transplantation for cancer.

There is growing recognition that the experience of cancer can have a positive as well as a negative psychological impact. This longitudinal study sought to identify predictors of posttraumatic growth among cancer patients (N=72) undergoing bone marrow transplantation. Greater posttraumatic growth in the posttransplant period was related to younger age; less education; greater use of positive reinterpretation, problem solving, and seeking alternative rewards as coping strategies in the pretransplant period; more stressful appraisal of aspects of the transplant experience; and more negatively biased recall of pretransplant levels of psychological distress. Findings partially support J. A. Schaefer and R. H. Moos's (1992) model of life crises and personal growth and also suggest that temporal self-comparisons contribute to the experience of posttraumatic growth.     

Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia

Fibromyalgia (FM ) is a chronic pain syndrome characterized by high levels of psychological distress and alexithymia, a personality disposition affecting emotional self‐awareness. The main aim of the present study was to investigate for the first time the relationship between alexithymia and coping strategies on the one hand, and alexithymia and perceived social support on the other, in a sample of FM patients. To reach this aim, 153 FM patients completed a battery of tests assessing coping strategies, perceived social support, alexithymia, psychological distress and pain intensity. Four regression analyses were performed to assess whether alexithymia was still a significant predictor of coping strategies and perceived social support, after controlling for psychological distress. High levels of both psychological distress and alexithymia were found in our sample of FM patients. Regarding coping strategies, FM patients reported higher scores on problem‐focused coping, with respect to the other two coping strategies. The regression analyses showed that the externally‐oriented thinking factor of alexithymia significantly explained both problem‐ and emotion‐focused coping, while the difficulty‐describing feelings factor of alexithymia proved to be a significant predictor of perceived social support. Only the variance of dysfunctional coping ceased to be uniquely explained by alexithymia (difficulty identifying feelings factor), after controlling for psychological distress, particularly anxiety. These results highlight a negative relationship between alexithymia and both the use of effective coping strategies and the levels of perceived social support in FM patients. An adequate assessment of both alexithymia and psychological distress should therefore be included in clinical practice with these patients.     

Minimal Contact Intervention with Autologous BMT Patients: Impact on QOL and Emotional Distress

Bone marrow transplantation (BMT) is often a last treatment option for individuals who have experienced relapse or treatment failure and is often accompanied by increased levels of distress and reductions in quality of life (QOL). Despite this, few studies have been designed to improve post-BMT QOL and reduce distress. The current study examined the course of distress and QOL in 26 autologus BMT patients and the effect on distress and QOL of providing a minimal contact workbook intervention. Physical well-being decreased following the BMT, but increased at 2- and 6-month follow-up assessments, and distress did not significantly vary over the course of the study for patients in the standard care and workbook intervention groups. Examination of the reasons for the lack of group differences revealed that approximately half of the individuals randomized to the workbook intervention did not look at the material; with those that did reporting higher QOL, decreased anxiety, more adaptive coping, and decreased religiosity. The results argue for the importance of targeting patients at need prior to the transplant procedure, triaging them based on specific characteristics, and providing treatments that match these characteristics.     

Coping After Bone Marrow Transplantation: The Predictive Roles of Optimism and Dispositional Coping

Bone marrow transplantation (BMT) is an invasive and taxing treatment for certain cancers. This study investigated the psychological constructs of optimism and dispositional coping and their relative predictive role for situational coping. Participants were 85 cancer patients enrolled in a randomized clinical trial of T-cell depletion for prevention of graft-versus-host disease (GVHD) who completed baseline and 1-year interviews. Results of simultaneous regression analyses showed that optimism did not predict situational instrumental or palliative coping strategies but was negatively predictive of situational avoidant coping. Each of the three situational coping strategies was most strongly predicted by the corresponding dispositional coping strategy. This research was sponsored by the National Heart, Lung and Blood Institute: N01-HB-47095, N01-HB-47097, N01-HB-47094 and N01-HB-47098.     

Coping strategies: A prospective study of patterns,stability, and relationships with psychological distress

The aims of this article are: (1) to explore patterns (clusters) of coping strategies; (2) to examine the stability of individual coping strategies and patterns of coping over time; and (3) to establish long term associations between coping and psychological distress. Coping strategies were assessed with the Brief Cope questionnaire, whereas psychological distress was measured with the ten‐item version of the Hopkins Symptom Checklist, in a two‐year prospective sample comprising 3,738 employees. Based on TwoStep cluster analysis of the Brief Cope, three different coping patterns were identified: low coping, engagement coping, and disengagement coping. Analyses of long‐term stability indicated malleable properties for the individual coping strategies as well as the three clusters. Disengagement coping strategies in the form of self‐blame and self‐distraction were most strongly associated with distress at follow‐up, whereas baseline distress was related to increased use of these strategies two years later. Coping patterns at baseline had no main effects on later levels of distress, but levels of distress at baseline predicted subsequent use of engagement and disengagement coping patterns. The finding that specific coping strategies are malleable suggests that it is possible to modify and develop dysfunctional strategies. The associations between disengagement coping strategies and distress indicate that this kind of coping is especially problematic with regard to mental health problems. A main contribution of this study is that it establishes cluster analytic techniques as beneficial in the assessment of coping.     

Patterns of coping with cancer.

We identified five patterns of coping in a sample of 603 cancer patients: "seeking or using social support," "focusing on the positive," "distancing," "cognitive escape-avoidance," and "behavioral escape-avoidance." Relationships of these coping patterns to sociodemographic characteristics, medical factors, stress appraisals, psychotherapeutic experience, and emotional distress were tested using correlational and regression techniques. Type of cancer, time since diagnosis, and whether a person was currently in treatment had few or no relationships to coping. The specific cancer-related problem (e.g., pain, fear of future) was also not associated with how individuals coped. Perceptions of its stressfulness, however, were related to significantly more coping through social support and more of both forms of escape-avoidance. Coping through social support, focusing on the positive, and distancing was associated with less emotional distress, whereas using cognitive and behavioral escape-avoidance was associated with more emotional distress. Implications of the results for understanding coping processes and intervention with cancer patients are discussed.     

Ethnicity, coping, and distress among Korean Americans, Filipino Americans, and Caucasian Americans

The authors examined appraisal, coping, and distress among Korean American, Filipino American, and Caucasian American Protestants. No interaction effects emerged among ethnic groups, but there were significant ethnic main effects for appraisal and coping. Compared with the Caucasian Americans, both Asian American groups appraised stressors as more challenging, and the Korean Americans appraised them also as greater losses. Both Asian American groups reported using more strategies of accepting responsibility, religious coping, distancing, and escape-avoidance than the Caucasian Americans did; the Filipino Americans also reported more problem-solving strategies than the Caucasian Americans. For all participants, challenge appraisals predicted adaptive coping (problem solving and positive reappraisal) and less distress. Problem solving, seeking social support, and positive reappraisal predicted less distress; self-control, accepting responsibility, and escape-avoidance predicted greater distress. The authors stressed the value of assessing ethnicity in coping research.     

Ethnicity,Coping, and Distress Among Korean Americans,Filipino Americans,and Caucasian Americans

Abstract

The authors examined appraisal, coping, and distress among Korean American, Filipino American, and Caucasian American Protestants. No interaction effects emerged among ethnic groups, but there were significant ethnic main effects for appraisal and coping. Compared with the Caucasian Americans, both Asian American groups appraised stressors as more challenging, and the Korean Americans appraised them also as greater losses. Both Asian American groups reported using more strategies of accepting responsibility, religious coping, distancing, and escape-avoidance than the Caucasian Americans did; the Filipino Americans also reported more problem-solving strategies than the Caucasian Americans. For all participants, challenge appraisals predicted adaptive coping (problem solving and positive reappraisal) and less distress. Problem solving, seeking social support, and positive reappraisal predicted less distress; self-control, accepting responsibility, and escape-avoidance predicted greater distress. The authors stressed the value of assessing ethnicity in coping research.     

Distress and Coping Strategies Among Patients with Skin Cancer

Non-melanoma skin cancer (NMSC) is the most common cancer world-wide, yet few studies have investigated the psychosocial implications of this disease. The current study provides an account of the distress experienced by patients with NMSC and the coping strategies they use to deal with the NMSC diagnosis. The results demonstrate that 19 % of the patients experience significant levels of psychological distress. Furthermore, those who engaged in avoidant coping strategies (specifically behavioural avoidance) were more likely to experience distress. These findings highlight the importance of further investigating this patient population, since patients report difficulties adjusting to this disease and its treatment.     

Psychological distress and well-being in advanced cancer: The effects of optimism and coping

This study examined the relations among optimism, coping, functional status, and psychological adjustment in 75 adults diagnosed with cancer. Both the positive and the negative aspects of psychological adjustment were assessed. All participants had been diagnosed with advanced stages of cancer (i.e., Stages II, III, and IV). Participants completed three assessments across a 4-month time period. Both optimism and coping were associated with psychological adjustment, even after controlling for functional status and prior adjustment. Additionally, optimism and coping were differentially related to distress and well-being. Optimism was strongly and positively associated with well-being and inversely related to distress. Escape-Avoidance coping was positively associated with distress and Accepting Responsibility coping was negatively associated with well-being. Comparisons between the current and prior studies indicated that individuals who are diagnosed with more advanced stages of cancer or who have survived bone marrow transplantation exhibit higher levels of optimism than do healthy individuals and individuals with early-stage disease.     

Psychological Distress Reported by Patients Undergoing Limb Reconstruction Surgery: Implications for Psychological Interventions

Limb reconstruction is an orthopaedic surgical technique designed to restore or improve functioning and appearance. The aims of the present study were to investigate levels of psychological distress in adults undergoing limb reconstruction as a result of traumatic injury, to examine which variables could account for any variations in distress during and after treatment, and to ascertain the potential relevance of psychological interventions. A cross-sectional sample of patients completed measures of psychological distress, posttraumatic symptomatology, coping, social support, pain, and disability. Self-reported levels of psychological distress and posttraumatic symptoms were high but did not tend to vary across stage of treatment, suggesting that distress is not solely attributable to limb reconstruction treatment per se but to other factors. Both medical variables (pain and mobility) and psychological variables (symptoms of trauma and coping strategies) accounted for a significant percentage of the variance in HAD scores. These results suggest that both medical and psychological interventions have potential for reducing distress and increasing well-being in an orthopaedic population who are experiencing high levels of emotional distress.     

Psychological distress and coping in nasopharyngeal cancer: an explorative study in Western Europe

Nasopharyngeal carcinoma (NPC) is the head and neck cancer with the greatest impact on patients’ quality of life. The aim of this explorative study is to investigate the psychological distress, coping strategies and quality of life of NPC patients in the post-treatment observation period. Twenty-one patients disease-free for at least two years were assessed with a medical and a psycho-oncological evaluation. Clinically relevant depressive symptoms (CRD) were present in 23.8% of patients and 33.3% reported clinically relevant anxiety symptoms (CRA). Patients with CRD and CRA showed a significantly higher score in the use of hopelessness/helplessness and anxious preoccupation coping strategies and a worse quality of life. Even in the post-treatment period, about a quarter of patients showed CRD and CRA. Results showed that patients with high anxiety or depressive symptoms seem to use dysfunctional coping strategies, such as hopelessness and anxious preoccupation, more than patients with lower levels of anxiety and depression. The use of these styles of coping thus seems to be associated to a higher presence of CRA or CRD symptomatology and to a worse quality of life.     

Counterfactuals, coping strategies and psychological distress among breast cancer patients

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

La gestion de la souffrance par le psychologue clinicien. Étude des impacts et des stratégies de coping

We focus in this study on strategies used by clinical psychologists to cope with their own or patient psychological distress in the framework of help relationship. A self-administered form was sent to listings of professionals by e-mail. The sample is made of 187 French clinical psychologists. To cope with patients’ suffering, psychologists use mostly avoidance coping style. And the strategies they prefer are “supervision”, “personal therapy” and “speaking with colleagues” (problem focused coping strategies). To cope with their own distress, which has a lot of negative impacts on help relationship, psychologists have most frequently a problem focused coping style but their favourite strategy is to “lighten their schedules”. And almost a quarter of the sample presents a significant level of distress. In conclusion, results show that psychological distress management by psychologists is an important question with a lot of ethical questions.     

Different Associations of Health Related Quality of Life with Pain,Psychological Distress and Coping Strategies in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disorder

The primary aim of this study was to measure psychological distress, pain severity, health related quality of life (QOL) and pain coping strategies in patients with irritable bowel syndrome (IBS) and ulcerative colitis (UC). A second aim was to determine the influence of somatic and psychological variables on health related QOL. Eighty-eight IBS and 66 UC patients completed the Irritable Bowel Syndrome Quality of Life Questionnaire (IBSQOL), Pain Severity Scale of West Haven Yale Multidimensional Pain Inventory (WHYMPY), Symptom Checklist-90-R (SCL-90-R) and Coping Strategies Questionnaire (CSQ). T-tests and GLM Analysis of Covariance were used for statistical analysis. IBS patients had significantly higher levels of psychological distress, pain severity and maladaptive pain coping strategies (catastrophization), and lower QOL than UC patients. Variance of QOL in IBS was explained for the most part by catastrophization (15%), then by psychological distress (8%), and for the less part by pain severity (5%). In UC, pain severity explained 21%, psychological distress 8%, and catastrophization 3% of the variance of QOL. These results suggest there are differences between IBS and UC patients in the role of physical and psychological factors in QOL and emphasize the importance of cognitive processes in IBS.     

Self-mutilation and coping strategies in a college sample

The goal of this study was to examine the use of specific coping strategies among self-mutilating college students. The self-mutilating group (n = 44) reported utilizing avoidance strategies more often than did a control group (n = 44) matched for general psychological distress but with no history of self-mutilation. In addition, female, but not male, self-mutilators endorsed using problem-solving and social support seeking strategies less often than nonmutilators. These findings suggest that coping strategies in general and avoidance-based strategies in particular may be important targets for the treatment of self-mutilative behaviors.     

Pain language of bone marrow transplantation patients.

Previous studies have shown that hypnosis may be effective in reducing intensity of pain among bone marrow transplantation patients whereas cognitive behavioral intervention without imagery was not effective for this group of patients. Since hypnosis alters patients' perception of pain and cognitive behavioral intervention changes patients' beliefs and improves their coping with pain, we hypothesized that sensory pain is more important than affective pain in understanding the pain experience of patients undergoing bone marrow transplantation. To test this hypothesis we administered the McGill Pain Questionnaire longitudinally to 50 consecutive eligible recipients of bone marrow transplantation during hospitalization to assess the different dimensions of pain they experienced. Consistent with our hypothesis, sensory pain fluctuated with treatment stages, and the pattern was consistent with previous findings. Patients reported significantly higher sensory pain than affective pain at all assessment points. In contrast, affective pain remained low and stable throughout the treatment. Our results contribute to the understanding of the nature of pain in bone marrow transplantation and suggest pain management strategies that focus on sensory pain as in hypnosis are more useful for such patients.