‘It was all intertwined’: Illness representations and self-management in patients with cancer and anxiety/depression

Objective: Cancer and anxiety/depression frequently co-occur, leading to poorer outcomes for these illnesses. However, the majority of existing research investigates how participants view single illnesses alone. This study aimed to explore the content of individuals’ multimorbid representations and how these relate to their coping behaviours and self-management strategies for cancer and anxiety/depression.

Design: A semi-structured qualitative research design with theoretical thematic analysis.

Main Outcome Measures: Multimorbid illness representations, coping behaviours, and self-management strategies.

Results: In interviews with 21 participants multimorbid representations varied, three participants viewed cancer and anxiety/depression as unrelated, five participants were uncertain about the relationship between cancer and anxiety/depression, and the majority of participants perceived cancer and anxiety/depression as related. This third group of participants often described relationships as causal, with representations having both positive and negative influences on coping behaviours and self-management strategies. Representations were shown to change over the course of the cancer experience, with fear of cancer recurrence and the influence of participants’ most challenging illness also discussed.

Conclusions: People hold multimorbid illness representations that can influence self-management. An awareness of these representations by researchers, health professionals, and patients is important for the creation of future interventions that aim to improve and maintain patient wellbeing.     

Adaptation, evolution, and religion

Neo-Darwinian theories of religion include both nonadaptationist and adaptationist versions. Nonadaptationist versions contend that the mental architecture of the brain is wired for religious thinking but that religious concepts have piggybacked on other cognitive adaptations, especially those for agency detection. Religious concepts are not evolved biological adaptations but rather by-products of more general cognitive structures that are adaptations. Adaptationist versions concentrate on the benefits provided by religion, such as increased social cohesion and the individual benefits that stem from it, such as better physical and mental health and greater longevity. After clarifying the meaning of the terms “adaptation” and “adaptationism,” this article presents four lines of evidence in favor of the adaptationist position: (1) in the ancestral environment the role of the shaman was nearly universal and was primarily devoted to the crucial human goals of curing illness and protecting and finding vital resources; (2) religion generally has positive effects on both physical and mental health; (3) religions tend to be pro-natalist and more religious people tend to leave more offspring than less religious or nonreligious people; (4) the major world religions that evolved in the first millennium BCE during a period of major social chaos and disruption emphasized an omnipotent, transcendent God of love and mercy who offered salvation in a heavenly afterlife and released individuals from earthly suffering. None of these facts demonstrate conclusively that cognitive modules specifically oriented to supernatural agents evolved by natural selection, but they are highly suggestive and make a good inferential case.     

INCREASING NURSES' USE OF FEEDBACK TO PROMOTE INFECTION-CONTROL PRACTICES IN A HEAD-INJURY TREATMENT CENTER

This study established regular implementation of a simple feedback procedure by supervisory nurses with their assistants at a head-injury treatment center. Five nurses were trained to distribute brief written comments to their assistants about infection-control practices, including using gloves to avoid contact with body fluids. Following low rates of written feedback, nurses met with the trainer weekly to set goals for using the system, to review feedback rates, and to examine contingent letters of appreciation. Written feedback increased from 0.09 to 0.58 per day. When outcome data on glove use were subsequently added to the feedback provided to nurses, nurses' feedback on glove use increased and overall glove use by assistants increased by 36.7% for 66.7% of assistants who responded to feedback. Assistants rated feedback as highly accurate and indicated some interest in receiving future feedback. However, nurses and assistants expressed a preference for oral over written feedback.     

Predicting Condom Use in African American STD Patients: The Role of Two Types of Outcome Expectancies1

This study examined the association of two types of condom use outcome expectancies (self-approval and partner reaction) with patterns of safer sexual behavior among predominantly African American patients at a sexually transmitted diseases (STD) clinic. As expected, both individuals' own self-approval outcome expectancies and their partner reaction outcome expectancies predicted consistency of condom use, although partner reaction expectancies predicted condom use above and beyond the effects of self-approval expectancies. Furthermore, individuals who believed that they and their partner shared positive condom use outcome expectancies reported the greatest use of condoms. These findings suggest that HIV prevention programs should address both types of condom use outcome expectancies in order to maximize behavior change.     

Key issues in the pastoral supervisory relationship

The supervisory relationship in pastoral counseling is examined with special focus on (1) the person of the supervisor; (2) the person of the student; (3) the learning contract; (4) the focus of the material presented in the supervisory session; (5) various supervisory models; (6) the dynamics of role modeling; and (7) the pastoral dimension of the relationship.     

Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder

One hundred thirty patients presenting at an anxiety disorders research clinic were administered a structured interview (i.e., Anxiety Disorders Interview Schedule-Revised). Diagnoses were made in accordance with Diagnostic and Statistical Manual (rev. 3rd ed.) criteria. Seventy percent of patients received at least one additional but secondary Axis I diagnosis. The most common additional diagnoses were simple and social phobia, which were assigned to nearly one third of all patients. In addition, 33% of anxiety disorder patients received an additional diagnosis of a depressive mood disorder (i.e., dysthymia or major depression). The distribution of specific additional diagnoses are presented for each principal anxiety disorder category. The scientific and clinical implications of comorbidity are discussed while considering the relatively high patterns of syndrome comorbidity found in the present study, which is consistent with several earlier studies.     

A comparison of directly recorded and derived acceleration data in movement control research

This paper compares acceleration-time histories that were recorded during a simple arm extension/flexion movement completed as fast as possible and at a slower rate. Directly measured accelerations from an accelerometer were used to obtain an optimum filter cut-off frequency for displacement data were to be subsequently differentiated. Dependent variables such as ‘zero line crossings’ and ‘significant deviations’ were measured using both the accelerometer data and the derived acceleration data.     

Social phobia features across the DSM-III-R anxiety disorders

One hundred sixty subjects meeting DSM-III-R criteria for the five major anxiety disorders were compared on the extent to which they reported features characteristic of social phobia. The results indicated that many patients in the anxiety disorder categories experience some degree of social anxiety. The differences between subjects with a primary diagnosis of social phobia and subjects with other anxiety disorders appear to be chiefly quantitative on this feature. Compared to the other anxiety disorders, social phobics report fear and avoidance in response to a greater number of social situations and report greater interference in their lives due to social phobic concerns. Among the anxiety disorders, generalized anxiety disorder appears to be associated with the greatest degree of social anxiety, and simple phobia with the least.     

Classical conditioning model of panic disorder: response to Wolpe and Rowan

We refute Wolpe and Rowan's (1989) classical conditioning theory of panic disorder based upon several lines of evidence presented above. While there is no doubt that hyperventilation and conditioning are important factors in the production of panic attacks, Wolpe and Rowan's (1989) hypothesis is inconsistent with recent data concerning the limited role of hyperventilation and the importance of cognitive mediation in the production of panic attacks.