Social comparison and adjustment to breast cancer: an experimental examination of upward affiliation and downward evaluation.

In a study designed to evaluate the divergence of social comparison activities under health threat, breast cancer patients (n = 94) were assigned randomly to listen to an audiotaped interview in which the target's psychological adjustment and disease prognosis were manipulated to reflect good, poor, and unspecified psychological and physical health status. Results supported hypotheses regarding downward self-evaluative and upward affiliative comparison activity, as well as predictions regarding the influences of comparison dimension. With regard to desire for affiliation, participants demonstrated a greater desire for information and emotional support from the well-adjusted target than from the poorly adjusted target. Self-evaluation of adjustment and prognosis varied as a function of target characteristics, although a pervasive tendency toward downward comparison in self-evaluation also was noted.     

Perceived partner support and psychosexual adjustment to breast cancer

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

Perceived partner support and psychosexual adjustment to breast cancer

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

Mismatches in social support and psychosocial adjustment to breast cancer.

Emotional support is known to provide psychosocial benefits for women with breast cancer, but women can experience a mismatch between support that is wanted and support that is received from their personal supporter. The role of wanted and unwanted support in psychosocial adjustment was examined in 79 women recovering from breast cancer. Four distinct patterns of desired support actions were found using cluster analysis. Patterns of wanted support were not related to better or worse psychosocial adjustment. However, a misalignment of support between the provider and the receiver significantly influenced psychosocial adjustment, and unwanted but received support (support commission) was uniquely associated with poor psychosocial adjustment. Clinical interventions using the support instrument could help match support providers' actions to receivers' preferences.     

Attributions, beliefs about control, and adjustment to breast cancer

Attributions for cancer and beliefs about control over cancer were examined for their association with adjustment to breast cancer. Although 95% of the respondents made attributions for their cancer, no particular attribution (e.g., stress, diet) was associated with better adjustment. Analyses of attributions of responsibility for the cancer to the self, environment, another person, or chance yielded only a negative relation between adjustment and blaming another person. In contrast, both the belief that one could now control one's cancer and the belief that others (e.g. the physician) could now control the cancer were significantly associated with good adjustment. Of the different types of control, cognitive control was most strongly associated with adjustment, behavior control was less strongly associated with adjustment, and information control and retrospective control were unassociated with adjustment. The theoretical and practical implications of these results are discussed.     

Psychological adjustment in breast cancer: processes of emotional distress.

The process of psychological adjustment to breast cancer was examined at diagnosis and at 3- and 6-month follow-ups in a sample of 80 women with Stage I-Stage IV breast cancer. At diagnosis, symptoms of anxiety/depression were predicted by low dispositional optimism, and this path was partially mediated by use of emotion-focused disengagement coping. Younger age also was predictive of anxiety/depression symptoms at time of diagnosis, and this relationship was fully mediated by magnitude of intrusive thoughts. At 3 months, changes in anxiety/depression symptoms were predicted only by intrusive thoughts. At 6 months, low dispositional optimism reemerged as a significant predictor of changes in anxiety/depression and again was partially mediated by the use of emotion-focused disengagement coping. Independent effects for problem-focused engagement and disengagement and emotion-focused engagement coping were also found at 6 months. Implications of these data for psychosocial interventions with breast cancer patients are highlighted.     

A longitudinal examination of couples' coping strategies as predictors of adjustment to breast cancer

This study's goals were to examine coping strategies of women and their male partners as predictors of change in women's adjustment over the year following breast cancer treatment and to test whether partners' coping processes interact to predict adjustment. In a sample of women who had recently completed breast cancer treatment and were taking part in a psychoeducational intervention trial, the patients' and partners' cancer-specific coping strategies were assessed at study entry (average of 10 months after diagnosis). Assessed at study entry and 20 months after diagnosis (n = 139 couples), dependent variables were women's general (i.e., vitality, depressive symptoms, relationship satisfaction) and cancer-specific adjustment (i.e., cancer-specific distress, perceived benefits). Both patients' and partners' coping strategies at study entry predicted change in women's adjustment at 20 months. Women's use of approach-oriented coping strategies predicted improvement in their vitality and depressive symptoms, men's use of avoidant coping predicted declining marital satisfaction for wives, and men's approach-oriented strategies predicted an increase in women's perception of cancer-related benefits. Patients' and partners' coping strategies also interacted to predict adjustment, such that congruent coping strategy use generally predicted better adaptation than did dissimilar coping. Findings highlight the utility of examining patients' and partners' coping strategies simultaneously.     

Negative support of significant others affects psychological adjustment in breast cancer patients

Significant others play an important role in providing support in patients’ lives, but some types of support negatively affect the patients. This study was conducted in early-stage breast cancer patients to examine the structure of support, which was provided by their significant others and assessed negatively by the patients, and to identify negative support relating to the psychological adjustment of these patients. Thus, we first conducted interviews among 28 breast cancer patients to identify these support items assessed as negative; next, we conducted a questionnaire survey using the resulting items in 109 postoperative patients who had early-stage breast cancer. We performed exploratory and confirmatory factor analyses and obtained a valid second-order factor structure, including superordinate factors (excessive engagement, avoidance of problems and underestimation) and subordinate factors (overprotection, encouragement and management). Among these factors, the avoidance of problems was the only factor to be negatively associated with psychological adjustment of the patients, suggesting that these patients receive problem-avoiding support. The results of our study suggest that such problem-avoiding support from significant others can be counter-productive and potentially worsen the psychological adjustment of breast cancer patients.     

Negative support of significant others affects psychological adjustment in breast cancer patients

Significant others play an important role in providing support in patients' lives, but some types of support negatively affect the patients. This study was conducted in early-stage breast cancer patients to examine the structure of support, which was provided by their significant others and assessed negatively by the patients, and to identify negative support relating to the psychological adjustment of these patients. Thus, we first conducted interviews among 28 breast cancer patients to identify these support items assessed as negative; next, we conducted a questionnaire survey using the resulting items in 109 postoperative patients who had early-stage breast cancer. We performed exploratory and confirmatory factor analyses and obtained a valid second-order factor structure, including superordinate factors (excessive engagement, avoidance of problems and underestimation) and subordinate factors (overprotection, encouragement and management). Among these factors, the avoidance of problems was the only factor to be negatively associated with psychological adjustment of the patients, suggesting that these patients receive problem-avoiding support. The results of our study suggest that such problem-avoiding support from significant others can be counter-productive and potentially worsen the psychological adjustment of breast cancer patients.     

The Big Five and identification–contrast processes in social comparison in adjustment to cancer treatment

The present study examined the relationship between social comparison processes and the Big Five personality factors. In a sample of 112 patients with various forms of cancer it was found that Neuroticism was associated with a tendency to focus on the negative interpretation of social comparison information that expressed itself in identification with fellow patients who were doing worse. This identification process also seemed to mediate the (negative) relationship between Neuroticism and post‐treatment feelings of mastery and uncertainty. No relationship was found between Neuroticism and the tendency to contrast one's situation against the situation of others who are doing better. Unexpectedly, Extraversion was most strongly related to a tendency to contrast one's situation against the situation of fellow patients who are doing better. Agreeableness, Conscientiousness and Intellect/Autonomy were unrelated to social comparison. The therapeutical implications of the findings for cancer patients are discussed. Copyright © 1999 John Wiley & Sons, Ltd.     

Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer.

The authors report a 3-year follow-up of the effects of 8-week support group interventions on the quality of life of women with early stage breast cancer. Shortly after diagnosis, women were randomly assigned to 1 of 4 conditions: control, education, peer discussion, and education plus peer discussion. The education group intervention focused on providing information to enhance control over the illness experience, whereas the peer discussion group intervention focused on providing emotional support through the expression of feelings. Consistent with the results that emerged 6 months after the interventions (V. S. Helgeson, S. Cohen, R. Schulz, & J. Yasko, 1999), the authors found that the benefits of the education intervention were maintained over a 3-year period (N=252), although effects dissipated with time. The authors continued to find no benefits of the peer discussion intervention, either alone or in combination with education.     

Psychological adjustment to cancer in a collective culture

We examined the associations between social support, health locus of control, neuroticism, and psychological adjustment (PA) in 152 Hong Kong Chinese patients. Our objective was to assess hypotheses relevant to the cohesive family structure, and the belief in external sources of control that pervade this culture. Use of social support by individuals who reported reliable support, and internal locus of control (ILOC) associated positively, and neuroticism associated negatively with PA. The independent variables accounted for up to 39% of the variance in PA measures. Our findings provide rare information about coping with serious illness in a non‐Western culture. They illustrate the centrality of family relationships in Chinese culture. They suggest that even in a culture where supernatural beliefs are widespread, ILOC relates positively and “chance” beliefs relate negatively to adjustment. Finally they support the importance of controlling for neuroticism in examining stress.     

Locus of control and adjustment to cancer

The English form of the Cancer Locus of Control Scale was administered to an heterogeneous sample of 68 cancer patients. A principal components analysis confirmed the three subscales described in the original Dutch form, however, with five items excluded. Correlations with other measures indicated that high internal control over the course of the illness was associated with a tendency to adopt an attitude toward cancer of 'fighting spirit' whereas high internal control over the cause of the illness was associated with an 'anxious preoccupation' about cancer. No specific relationship was found between scale scores and either depression and anxiety or the tendency to be emotionally controlled. It was concluded that the scale provides a valid measure of perceptions of control of cancer patients and is a useful method of assessing these important psychological responses.     

Psychological and physical adjustment to breast cancer over 4 years: identifying distinct trajectories of change.

The goal of this study was to identify distinct trajectories of adjustment to breast cancer over 4 years as well as to distinguish among the different trajectories. The mental and physical functioning of 287 women with breast cancer who remained alive and disease free through 4 years of follow-up were examined. The majority of women showed slight and steady improvement in functioning with time, but subgroups of women were identified who showed marked improvement and marked deteriorations over time. Age successfully distinguished different trajectories of physical functioning. Indices of personal resources (i.e., self-image, optimism, perceived control) and social resources (i.e., social support) successfully distinguished different courses of mental and physical functioning.     

Immediate breast reconstruction and psychological adjustment in women who have undergone surgery for breast cancer: a preliminary study

Current debate exists regarding the timing of reconstructive surgery following mastectomy for breast cancer, with research pointing in favour of immediate reconstruction. This cross-sectional study sought to compare the psychological outcome of breast cancer treatment in women who had either received mastectomy and immediate reconstruction using autogenous tissue (n?=?30), or mastectomy alone (n?=?34), and also determine adjustment factors in this population as a whole. Participants completed measures of depression, anxiety, body image, self-esteem, coping and perceived social support at a time point 3?-?15 months after initial surgery. No significant differences were revealed between the two groups on any of the outcome measures. Poor body image, low self-esteem, and a tendency to use coping strategies characterized by helpless/hopelessness and anxious preoccupation, rather than fighting spirit, were highly predictive of distress. Reasons for the lack of differences between the two groups are explored.     

Dimensions of cancer locus of control scale as predictors of psychological adjustment and survival in breast cancer patients

The Cancer Locus of Control Scale, to investigate specific beliefs of control in cancer patients, was validated previously with an English-speaking population. This study tested the construct and concurrent validity of a 17-item French version of the scale and explored its relations with psychological adjustment and with adaptation assessed two years later. In a sample of 157 women diagnosed with a first breast cancer, the French version was administered along with the Body Image Questionnaire, the State-Trait Anxiety Inventory, the Perceived Stress Scale, the Social Support Questionnaire, and the Ways of Coping Checklist. A factor analysis performed on scores identified the three original factors: internal causal attribution, control over the course of the illness, and religious control. Internal causal attribution was associated with high scores for state and trait anxiety, negative body image, emotion-focused coping, and problem-focused coping. Control over the course of the cancer was positively associated with scores on both problem- and emotion-focused coping. Religious control was negatively associated with perceived stress. Emotional adjustment and quality of life were assessed in 59 of the 157 breast cancer patients two years after diagnosis and original testing. Hierarchical regression analyses indicated that internal causal attribution significantly predicted 38.1% of the variance in rated state anxiety. None of the dimensions of the Cancer Locus of Control Scale predicted the duration of survival measured two years later in 75 of the 157 patients.     

Social goals: Relationship to adolescent adjustment and to social problem solving

Examined the relations between adolescent boys' social goals of dominance, revenge, avoidance, and affiliation and (1) self-reported negative adolescent outcomes; (2) subjective sense of self-esteem; and (3) externalizing, internalizing, and prosocial behaviors, as rated by peers and teachers. Results indicated that social goal values were related to diverse aspects of self-, teacher-, and peer-reported social and behavioral functioning, with a consistent association found between a range of delinquent, substance-using, and behavioral difficulties, and endorsement of high goal values for dominance and revenge and low goal values for affiliation. Results also indicated that teacher-identified aggressive boys differed from nonaggressive boys in the value they placed on social goals, with aggressive boys placing a higher value on goals of dominance and revenge, and lower value on goals for affiliation. Finally social goal choice had a clear relation to the social problem-solving differences of aggressive and nonaggressive boys.This study was funded by a research grant for the National Institute of Mental Health (MH 39989). Acknowledgment is made for the administrative support provided by the Durham County Schools and The Durham Community Guidance Clinic of the Duke University Medical Center.     

Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis.

Cancer patients experience positive as well as adverse consequences from diagnosis and treatment. The study reported here examined longer term reverberations of such experiences. A set of benefit-finding items along with measures of well-being were completed by 230 early-stage breast cancer patients in the year postsurgery. Four to 7 years later, 96 of them again completed measures of well-being. Controlling for initial distress and depression, initial benefit finding in this sample predicted lower distress and depression at follow-up.