Psychological support needs of patients with head and neck cancer and their caregivers: A qualitative study

Objective: The aim of this study was to explore the psychological support needs of patients with head and neck cancer (HNC) and their caregivers. The appropriate timing, length, format and content of sessions were also investigated.

Design: Eighty-three patients with HNC and 73 of their caregivers completed questionnaires at diagnosis. Follow-up questionnaires were mailed to patients six months later.

Main outcome measures: Free text-comments to open-ended questions in the questionnaires were analysed using an inductive thematic approach with coding and theme development directed by the content of responses. This was used to determine psychological support needs both at diagnosis and at six month follow-up.

Results: Patients described ‘just being there’, empathy, maintaining normality and practical support as helpful from family/friends. They desired information, honesty, positivity and empathy from clinical staff. Formal psychological support was desired by approximately 40% of patients and caregivers, particularly early after diagnosis and during treatment. Most participants desired face to face sessions, providing individualised information and coping strategies.

Conclusion: The results of this study suggest that psychological interventions for patients with HNC and their caregivers should be delivered early after diagnosis in face to face sessions, presenting honest and factual information about the disease and coping strategies.     

Revised reinforcement sensitivity theory: The impact of FFFS and stress on driving

This study investigated the effect of a fear-based personality trait, as conceptualized in Gray’s revised reinforcement sensitivity theory (RST) by the strength of the Fight/Flight/Freeze system (FFFS), on young people’s driving simulator performance under induced psychosocial stress. Seventy-one young drivers completed the Jackson-5 questionnaire of RST traits, followed by a psychosocial stress or relaxation induction procedure (random allocation to groups) and then a city driving simulator task. Some support was found for the hypothesis that higher FFFS sensitivity would result in poorer driving performance under stress, in terms of significantly poorer hazard responses, possibly due to an increased attentional focus on the aversive cues inherent in the stress induction leaving reduced attentional capacity for the driving task. These results suggest that stress may lead to riskier driving behaviour in individuals with fearful RST personality styles.     

Toward an Ecological Theory of the Norms of Practical Deliberation

Abstract: Practical deliberation is deliberation concerning what to do governed by norms on intention (e.g. means‐end coherence and consistency), which are taken to be a mark of rational deliberation. According to the theory of practical deliberation I develop in this paper we should think of the norms of rational practical deliberation ecologically: that is, the norms that constitute rational practical deliberation depend on the complex interaction between the psychological capacities of the agent in question and the agent's environment. I argue that this view does a better job of justifying particular norms for practical deliberation than intrinsic or constitutivist theories. Finally, I argue against the Myth Theory of deliberation, which takes there to be no such norms on deliberation.     

Testing the effects of an expectancy-based intervention among adolescents: Can placebos be used to enhance physical health?

It has been suggested that the well-known health benefits associated with exercise can be explained by a placebo effect, and that greater effort should be given to convince people that their current behaviors have desirable health consequences. The overall purpose of this study was to test the efficacy of this "mind-set matters" hypothesis through the use of an expectancy-based intervention with adolescents. The study involved a four week randomized controlled trial with 348 Grade 9 adolescents (M (age)?=?14.07 yrs, SD?=?0.30), from four high schools, taking part in either a placebo-intervention condition (n?=?188) or a control condition (n?=?160). Participants in the placebo-intervention condition were informed that what they are already doing in school physical education lessons fulfills current recommendations for an active lifestyle. Participants in the control condition were not given this information. Four weeks after the intervention, adolescents in the placebo-intervention condition did not demonstrate significant changes in physiological health-related measures (diet, weight, body mass index, percentage body fat, heart rate, mean arterial pressure). The findings question the external validity of the "mind-set matters" hypothesis with adolescents, and suggest that simply encouraging adolescents to believe that they are healthy may not enable them to respond with improved indicators of physical health.     

Pediatric Feeding Disorders: A Quantitative Synthesis of Treatment Outcomes

A systematic review of the literature regarding treatment of pediatric feeding disorders was conducted. Articles in peer-reviewed scientific journals (1970–2010) evaluating treatment of severe food refusal or selectivity were identified. Studies demonstrating strict experimental control were selected and analyzed. Forty-eight single-case research studies reporting outcomes for 96 participants were included in the review. Most children presented with complex medical and developmental concerns and were treated at multidisciplinary feeding disorders programs. All studies involved behavioral intervention; no well-controlled studies evaluating feeding interventions by other theoretical perspectives or clinical disciplines met inclusion criteria. Results indicated that behavioral intervention was associated with significant improvements in feeding behavior. Clinical and research implications are discussed, including movement toward the identification of key behavioral antecedents and consequences that promote appropriate mealtime performance, as well as the need to better document outcomes beyond behavioral improvements, such as changes in anthropometric parameters, generalization of treatment gains to caregivers, and improvements in nutritional status.     

Written emotional disclosure buffers the effects of social constraints on distress among cancer patients.

The aims of the present study were to examine whether written emotional disclosure would reduce distress among cancer patients and whether it would buffer the effects of high levels of social constraint (negative social responses to patients' expressions of emotion regarding their cancer) on distress. Cancer patients (N=104) were randomly assigned to write about their emotions regarding their cancer 20 min a day for 3 days or to write about a nonemotional topic. They completed questionnaires at baseline and 6 months postintervention. Results showed that written disclosure buffered the effects of social constraints on stress at the 6-month follow-up and that avoidance partly mediated these effects. The present data reinforce the notion that interventions should be tailored to patients' needs.