How Do Geneticists and Genetic Counselors Counsel Women from High-Risk Breast Cancer Families?

This qualitative study asked Australian Genetic Counselors and Clinical Geneticists working in cancer genetics to describe their practice when a woman attends a consultation about her family history and her risk of developing breast cancer. Twenty-nine out of 36 Clinical Geneticists/Genetic Counselors returned the questionnaire (82%). Participants identified the key goals of the consultation as (a) identifying the individual needs and concerns of the woman, (b) providing information on genes and chromosomes, (c) giving an individual risk assessment in the context of supportive interaction, and (d) discussing the pros and cons of genetic testing and putting a surveillance plan into place. Respondents emphasized the dual importance of counseling/support and information provision in this setting, suggesting that one could not be given without the other. Implications for clinical practice are discussed.     

The feeling of the story: Narrating to regulate anger and sadness

Admonitions to tell one's story in order to feel better reflect the belief that narrative is an effective emotion regulation tool. The present studies evaluate the effectiveness of narrative for regulating sadness and anger, and provide quantitative comparisons of narrative with distraction, reappraisal, and reexposure. The results for sadness (n?=?93) and anger (n?=?89) reveal that narrative is effective at down-regulating negative emotions, particularly when narratives place events in the past tense and include positive emotions. The results suggest that if people tell the “right” kind of story about their experiences, narrative reduces emotional distress linked to those experiences.     

A five-year follow-up of patients with borderline pathology of childhood

Borderline pathology of childhood (BPC) may be a precursor of personality disorders. There is a lack of data concerning outcome in adolescence. A group of 59 adolescents, who had been treated as children in a Child Psychiatry Day Hospital five to seven years earlier, was evaluated. Using the child version of the Retrospective Diagnostic Interview for Borderlines, 28 participants had been diagnosed with BPC while the remaining 31 participants who did not have a history of BPC served as the comparison group. The youth and their parents were given a battery of measures assessing current psychopathology and functional status. The group with a history of BPC was more likely than the comparison group to exhibit a combination of internalizing and externalizing behavior problems. Adolescents with a history of BPC were more impaired than the comparison group on a global measure of functional status. Compared to children with no history of BPC, children diagnosed with BPC are more likely to display poorer functioning as adolescents and continue to be at risk for psychopathology during adolescence. Future directions for research are discussed.     

Cognitive-behavioral treatment groups for people with chronic physical illness in Hong Kong: reflections on a culturally attuned model

This study describes and evaluates a cognitive-behavioral treatment group for people with chronic physical illness in Hong Kong. We developed a group protocol based on the understanding that Chinese people generally prefer a structured group format, expect group leaders to be active and directive, and are not used to expressing opinions and emotions in groups. The experimental and waitlist control groups had 38 and 35 participants, respectively. A standardized questionnaire was administered to all participants before and after the group treatment. Results suggest that members of the experimental group showed improvements in mental health, negative automatic thoughts, and negative emotions when compared to those in the waitlist control groups, and at the end of group treatment. Implications for designing and running a culturally attuned CBT group for Chinese people are discussed.     

Freedom, Fiction and Evidential Decision Theory

This paper argues against evidential decision-theory, by showing that the newest responses to its biggest current problem – the medical Newcomb problems – don’t work. The latest approach is described, and the arguments of two main proponents of it – Huw Price and CR Hitchcock – clearly distinguished and examined. It is argued that since neither new defence is successful, causation remains essential to understanding means-end agency.     

Gendered Career Paths: A Life Course Perspective on Returning to School

We applied a life course perspective to an examination of work-to-school transitions, and highlighted the individual and family-level factors that differentially shape the career pathways of men and women. We employed data from a sample of employed middle-class men and women in dual-earner couples (N?=?1,408 couples) to examine the relationship between returning to school and prior educational attainment, individual biographic pacing (age, timing of marriage), job history, current job conditions, psychological resources, and family demands. Results support several hypothesized gender differences in the return to school pathway. Women with the heaviest combination of work and family demands were the most likely to return, an unexpected finding that we discuss with reference to both personal and structural resources.     

Predictors of Cancer Worry in Unaffected Women from High Risk Breast Cancer Families: Risk Perception is not the Primary Issue

Some women at increased familial risk of breast cancer experience elevated levels of cancer-specific worry, which can possibly act as a barrier to screening, and may be a significant factor in decisions regarding risk-reducing surgery. The aim of this study was to comprehensively examine predictors of cancer-specific worry in high risk women and to test a model which proposes that perceived breast cancer risk mediates the impact of other factors on worry. 1,437 unaffected women from high risk breast cancer families completed questionnaires and interviews. Path analysis was used to test the model of potential predictors of cancer worry, including familial, personal and psychological variables, mediated via perceived cancer risk. Levels of cancer-specific worry were generally low despite an average perceived risk of 50.3%. The goodness-of-fit of the proposed model was poor, explaining only 9% of the variance for perceived risk and 10% of the variance for cancer specific worry. An alternative model of a direct relationship between all of the predictor variables and cancer worry, explained 24% of the variation in cancer worry. General anxiety, perceived risk, the stressful impact of recent cancer related events, a relative risk greater than 10, being closer in age to the youngest breast cancer diagnosis in family, and knowledge of personal mutation status, all independently contributed to cancer worry. Addressing general affective responses, experiences of recent cancer related events, in addition to education about personal risk, should be considered in counselling women with elevated cancer worry. Risk perception appears to act independently of other factors in its formulation and impact on cancer worry. Further research on the way in which women come to perceive their risk is indicated. The kConFab Psychosocial Group are (in alphabetical order of institution): Brain and Mind Institute, University of Sydney, Australia (I Hickie) Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia (K-A Phillips) Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia (B Bennett, B Meiser, K Tucker) Department of Oncology, St Vincent’s Hospital, Melbourne, Australia (S-A MaLachlan) Department of Psychological Medicine, Royal North Shore Hospital, St Leonards, Australia (C Tennant); Medical Psychology Research Unit, University of Sydney, Australia (P Butow, M Price).