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Medical illness and positive life change: Can crisis lead to personal transformation?
No full textPeople often claim to experience improved relationships with family and friends, a clearer sense of their own strengths and resilience, changed priorities about what is important in life, and various other positive changes after struggling with stressful or traumatic events. What are we to make of these claims? Can we determine whether perceptions of change reflect real, verifiable change--that is, is it possible for someone to believe that he or she has grown while still exhibiting the same self-defeating thoughts and behaviors? Or is the perception of change itself an important meaning reconstruction process? What factors influence personal growth, and what effect does growth have on physical and mental health? This book examines these issues in depth and draws out their implications for research and clinical practice. Because medical illness has been one of the primary contexts in which researchers have studied the phenomenon of positive life change, this book focuses on how positive life change might be fostered in the context of medical illness. (PsycINFO Database Record (c) 2009 APA, all rights reserved
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Measurement of Psychosocial Resources, Allostatic Load, and Their Relations
Full text linkBackground: The present four studies aimed to develop comprehensive, succinct measures of psychosocial resources and system-wide physiological dysregulation (allostatic load) and integrate these into a conceptual model, a modified form of the Reserve Capacity Model (Gallo & Matthews, 2003), to characterize how socioeconomic status, stress, psychosocial factors, mood, physiology, and health behaviors contribute to health outcomes.Methods: Identification of factors underlying psychosocial resources was conducted in four independent samples in which a range of psychological and social resources were measured. A systematic review of psychosocial resources and allostatic load was conducted by retrieving all articles with "allostasis" or "allostatic load" in the title, abstract, or keywords from major databases. An allostatic load factor was examined using data from the large Midlife in the United States (MIDUS) study, which was also used for the final study linking SES, psychosocial resources, health behaviors, allostatic load, and a health outcome.Results: In the first study, two factors, psychological and social resources, provided the best fit to all the psychosocial resources assessed. In Study 2, evidence of a common factor, allostatic load, underlying 23 biomarkers in MIDUS emerged, although there was also evidence of unique system-specific factors. In the systematic review of psychosocial resources and AL, results were mixed, with some studies finding null effects, and others finding significant positive or negative effects of psychosocial resources on allostatic load. In a fourth study testing the modified Reserve Capacity Model, results largely supported the model's predictions. SES was associated with better health outcomes indirectly via lower allostatic load, lower negative mood, and higher physical activity. These associations were themselves linked to SES via psychological resources and major stressful life events. Psychological resources were associated with higher physical activity, but not directly to allostatic load or health outcomes, and social resources had no association independent of psychological resources.Conclusions: Psychological resources, social resources, and allostatic load form coherent constructs. Psychosocial resources appear more strongly associated with health behaviors than directly to allostatic load or health outcomes. Results generally supported the modified Reserve Capacity Model, suggesting it is a useful conceptual framework to guide future research
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Stigma and Health-Related Adjustment in Lung Cancer Patients: A Longitudinal Analysis of Moderators and Mediators
Full text linkStigma and discrimination confer risk for poor mental and physical health for lung cancer patients, and research is needed to understand how and for whom stigma and discrimination are associated with poorer health-related adjustment. Although research has consistently demonstrated that the majority of lung cancer patients report experiences of stigma, longitudinal studies are needed to assess temporal relationships between lung cancer stigma and health-related adjustment. Additionally, no study has tested the unique contributions of lung cancer stigma and discrimination on psychological and physical health-related outcomes. Study 1 examined internalized lung cancer stigma (i.e., feelings of guilt, shame, and self-blame about one’s lung cancer diagnosis) and perceived subtle discrimination (i.e., perceptions of unfair treatment due to one’s lung cancer status that are ambiguous or low in intensity) as predictors of psychological and physical health outcomes across 12 weeks in 101 men and women on active treatment for lung cancer (any stage, any diagnosis duration). Based on theory and evidence, Study 2 tested whether sleep disturbance mediated relationships between lung cancer stigma and discrimination with poorer health-related adjustment in the same sample of lung cancer patients. Participants completed questionnaires at study entry and at 6- and 12-week follow-up. Findings from Study 1 indicated that internalized stigma and perceived subtle discrimination were uniquely and significantly associated with worse global quality of life and poorer psychological outcomes at study entry. Internalized stigma also predicted significant declines in global quality of life and increases in depressive symptoms and anxiety across time. Overall, the pattern of findings indicated that higher internalized stigma was a robust and independent predictor of declines in health-related outcomes across 12 weeks, whereas perceived discrimination was not. Study 1 also tested whether protective psychological processes (i.e., self-compassion, coping strategies) attenuated significant relationships between stigma and discrimination with health outcomes. Higher self-compassion and lower avoidant coping significantly moderated relationships between stigma and discrimination and psychological health. Specifically, when self-compassion was relatively high and avoidant coping was relatively low, internalized stigma and discrimination were not associated significantly with poorer psychological health. When self-compassion was relatively low and avoidant coping was relatively high, however, higher internalized stigma and higher perceived discrimination were associated with higher depressive symptoms and cancer-related anxiety, respectively.Results from Study 2 demonstrated that lung cancer patients evidenced prominent sleep disturbance, as measured through subjective and objective measures. Perceived subtle discrimination (but not internalized stigma) was associated significantly with higher subjective sleep disturbance at study entry and across time, and subjective sleep disturbance was robustly associated with poorer psychological and physical health. At study entry, higher subjective sleep disturbance significantly mediated the association between higher perceived subtle discrimination and higher depressive symptoms, worse global and cancer-specific quality of life, higher cancer-related anxiety, and more bothersome physical symptoms. Overall, the pattern of findings in Study 2 indicated that higher perceived discrimination was robustly associated with poor sleep, which may explain, in part, the significant relationships observed between higher perceived discrimination and poorer psychological and physical health-related outcomes in Study 1. Future research is recommended to develop health care provider- and patient-focused interventions to reduce lung cancer stigma and test whether such interventions promote health and well-being for this underserved and understudied population
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Psychosocial contributors to psychological and physical health-related outcomes in adults with poor prognosis cancer and their caregivers
Full text linkBackground: Psychosocial correlates of mental and physical health related outcomes in poor-prognosis cancers are relatively understudied in comparison more favorable prognosis cancers. Relevant theory in stress and coping and social cognitive processes posit associations among cognitive appraisals, coping processes and adjustment to stressors and that these processes occur in a social context. Diagnosis of poor-prognosis cancer represents a profound health threat and activates cancer-related appraisals, including assessments of treatment goals and survival, as well as coping processes in attempts to mitigate the impact of the stressor. A cancer diagnosis typically involves additional individuals that serve in a supportive role, termed caregivers. Two studies were designed to examine facets of illness perceptions, coping, and mental and physical health-related outcomes to inform theoretical understanding of these constructs and to identify potentially malleable treatment targets in adults diagnosed with poor-prognosis cancer and their caregivers. Method: Adults diagnosed with lung (n = 52) or pancreatic (n = 36) cancer and their primary caregivers (n = 48) were enrolled from 2017 to 2020 in two separate studies focused on the experience of each respective cancer. Patients and caregivers in both studies reported sociodemographic and medical characteristics as well as completed measures of depressive symptoms, anxiety, life disruption from pain, and approach- and avoidance-oriented coping processes. In Study 1, patients completed a measure of prognosis and treatment perceptions. Study 1 examined the association of prognosis and treatment perceptions with depressive symptoms, anxiety, and life disruption from pain as and the moderating capacity of coping processes in these hypothesized associations using multiple regression analysis. Study 2 examined the interdependence of patient and caregiver coping processes and depressive symptoms, anxiety, and life disruption from pain using Actor Partner Interdependence Modeling.
Results: Participants were adults who were diagnosed lung (n = 52) or pancreatic (n = 36) and their primary caregivers (lung n = 20, pancreatic n = 28). Both patients and caregivers were mostly older adults (patient M age = 66, caregiver M age = 62) who were white, well-educated, and financially secure. Nearly two-thirds of caregivers were women (n = 30, 62.5%), while about half the patients were women (n = 48, 54.5%). The overall sample was nearly 3 years post-initial diagnosis. Average depressive symptoms and anxiety were below clinical cutoffs, and average life disruption from pain was “within normal limits,” for both patients and caregivers. Rates of clinically elevated depressive symptoms in patients were lower than other advanced cancer samples and comparable to rates found in people with more favorable prognosis cancers. Patients diagnosed with pancreatic cancer reported clinically elevated anxiety at rates comparable to more favorable prognosis cancers, and lung cancer patients reported anxiety comparable with the general population. Caregivers reported levels of clinically elevated depressive symptoms and anxiety that were comparable to other advanced cancer samples and substantially greater than rates in the general population. Caregivers reported significantly higher rates of anxiety than patients, and patients diagnosed with pancreatic cancer and their caregivers reported greater anxiety than those diagnosed with lung cancer. Depressive symptoms, anxiety, and life disruption from pain did not differ as a function of gender. About one-third of patients reported a terminal illness perception, and there was discordance between perceived prognosis and treatment intent in about half the sample. Terminal (vs non-terminal) illness perception was associated with greater depressive symptoms and anxiety, but not with life disruption from pain. In patients, greater use of active coping was associated with lower depressive symptoms and buffered the association between terminal prognosis perception and greater depressive symptoms. Greater use of emotional processing coping was also associated with lower anxiety symptoms and buffered the association between terminal prognosis perception and greater anxiety symptoms. Greater acceptance coping was also associated with lower depressive symptoms. In caregivers, greater emotional expression coping was associated with lower depressive symptoms and less life disruption from pain. In both patients and caregivers, greater avoidance-oriented coping was associated with greater depressive symptoms and life disruption from pain and was also associated with greater anxiety in caregivers. Interdependence was observed between patient avoidance and caregiver depressive symptoms, though no other evidence of interdependence between patient and caregiver coping and outcomes was observed.
Conclusions: Both patients and caregivers reported clinically elevated depressive symptoms and anxiety at higher rates than the general population. Patients diagnosed with pancreatic cancer and their caregivers were particularly vulnerable to psychological distress. Approach-oriented coping processes related to the cancer experience of active coping, emotional processing, and acceptance coping were associated with favorable outcomes in patients, and active coping and emotional processing buffered the impact of terminal prognosis perception on depressive symptoms and anxiety, respectively. Emotional expression coping was beneficial in caregivers. Avoidance-oriented coping was maladaptive in both patients and caregivers and was interdependent between patients’ avoidance and caregivers’ depressive symptoms. Interventions may promote emotional expression in caregivers, and promote active coping, emotional processing, and acceptance in patients, and reduce experiential avoidance in patients in caregivers. Future research should focus on differential effects of prognosis perceptions and coping on mental and physical health-related outcomes at distinct points along the cancer trajectory, incorporate cultural considerations, and focus on adapting existing interventions to use in the context of poor-prognosis cancer
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Understanding and Promoting Medical Transition Readiness in Adolescents and Young Adults with Chronic Illness
Full text linkFew psychosocial interventions for adolescents and young adults (AYAs) with chronic illness aim to promote medical transition readiness (i.e., preparation to transfer from pediatric to adult medical care), an important developmental task. Inadequate medical transition readiness can result in poor psychological, financial and health-related outcomes. Guided by research and theory in Positive Youth Development (PYD), childhood chronic illness and medical transitions, the primary goals of the studies comprising this dissertation were to identify and promote factors that contribute to medical transition readiness. First, a systematic review of the literature was conducted to identify studies that assessed self-efficacy for disease management in AYA cancer survivors. In the second study, young adults with chronic illness were randomly assigned to a Coping Skills Intervention (CSI) condition, representing a life skills intervention in line with PYD theory; or a print control condition (Informational Materials; IM). All participants received weekly emails with information that aims to promote medical transition readiness. Participants in the CSI condition also attended an eight-week cognitive behavioral therapy group. Findings from the systematic review indicated 1) that self-efficacy for disease management is positively associated with health-promoting behaviors and inversely related to physical and mental health problems; and 2) that behavioral and educational interventions have the potential to increase self-efficacy. Results of the randomized controlled trial demonstrated that at two months (immediately post-intervention), CSI (vs. IM) participants were significantly more likely to have initiated the transition to adult medical care. There was no significant impact of group assignment on disease-related skills and knowledge, medical regimen adherence, quality of life, or depressive symptoms. CSI (vs. IM) group members demonstrated significantly higher illness-related benefit finding, self-efficacy and approach-oriented coping, as well as lower anxiety and perceived illness-related threat. Future research and clinical intervention refinement should build on the current findings by incorporating additional components of Positive Youth Development programs and by evaluating the CSI in diverse populations and settings. Additional directions for research include the need for validated measures of self-efficacy for disease management for AYA cancer survivors, as well as interventions that target the health care team’s role in promoting self-efficacy
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The Roles of Self-Affirmation and Emotional Disclosure in Promoting Adjustment to Chronic Financial Stress: An Experimental Investigation
Full text linkBackground: Chronic stress can damage individuals’ mental and physical health. Expressive disclosure about stressful events can decrease psychological distress and physical symptoms for individuals enduring a variety of chronic stressors (Frattaroli, 2006). The use of self-affirming statements about personal values is an active ingredient of expressive writing (e.g., Creswell et al., 2007). Additionally, when individuals face threat, their use of self-affirmation, or focusing on personally relevant values that are unrelated to the threat, can reduce their stress response (Creswell et al., 2005; Sherman, Bunyan, Creswell, & Jaremka, 2009). Few studies have examined the potential benefits of repeated self-affirmation on psychological and physical health beyond single laboratory sessions. This experimental study sought to integrate the existing research on expressive writing and self-affirmation theory by examining the effects of brief expressive writing and self-affirmation writing protocols on psychological and physical health over two months, compared to a control writing condition. Method: Undergraduate students experiencing chronic financial stress (N=110) were randomized to write about their most important value unrelated to finances (self-affirmation condition), their deepest thoughts and feelings about their financial stress (expressive writing), or how the spent their day (control condition) four times over the course of two laboratory sessions. Measures of mental and physical health were taken two weeks and eight weeks after their final writing session. The present study examined group differences in primary outcomes (negative affect, intrusive thoughts about finances, and physical symptoms) and secondary outcomes (symptoms of anxiety, depressive symptoms, and sleep) over time, as well as potential moderators (reward sensitivity and dispositional avoidance motivation) and mediators (increased positive affect, increased self-kindness, decreased avoidance coping) of self-affirmation and expressive writing. Results: Multilevel modeling analyses revealed that the linear trajectories of negative affect in the expressive writing and self-affirmation conditions differed significantly from the control condition, accounting for 32% variance of the linear trajectory of negative affect. Specifically, negative affect increased significantly over the study period for the control condition, whereas it decreased slightly but not significantly in the expressive writing condition and significantly decreased in the self-affirmation condition. Experimental condition had no significant effect on the five other outcomes (i.e., intrusive thoughts about finances, physical symptoms, symptoms of anxiety, depressive symptoms, and sleep). Dispositional reward sensitivity significantly moderated the effect of expressive writing, but not self-affirmation, on negative affect and physical symptoms. Individuals in the expressive writing condition who were lower in dispositional reward sensitivity evidenced significantly greater decreases in negative affect and physical symptoms over time compared to their counterparts in the control condition. The expressive writing and control conditions did not differ significantly on change in negative affect or physical symptoms for individuals who were high in dispositional reward sensitivity. Dispositional avoidance motivation did not moderate the effect of expressive writing or self-affirmation, and no significant mediated effects were found for either condition.Conclusions: Both expressive writing and self-affirmation may benefit undergraduates with chronic financial strain, particularly by buffering against increases in negative affect. Results also suggest that expressive writing might be especially beneficial for individuals who are low in reward sensitivity. However, because the present study was unable to identify mediators, continued research is needed to understand the other potential underlying mechanisms of self-affirmation (e.g., increased coping self-efficacy, sense of belonging, and reward processing). Emotional expression and reflection on personally-important values may be important components of, or combined to create, future interventions for individuals facing chronic stress
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Promoting Adjustment in Uveal Melanoma Survivorship: A Randomized Trial Targeting Illness Perceptions
Full text linkIntroduction: This dissertation project was a randomized controlled trial of a brief psychoeducational intervention targeting three illness perceptions (chronicity, control, coherence) in a sample of uveal melanoma (UM) survivors at UCLA (N = 101). Illness perceptions have been shown to be associated with psychological and disease-related adjustment in the context of chronic illnesses at large (e.g., Hagger et al., 2017), and within UM patient populations specifically (e.g., Hoch et al., 2023). More positive (i.e., less threatening) illness perceptions have been shown to be associated with better mental health outcomes in the context of chronic illness. Method: The intervention consisted of two psychoeducational videos in which participants’ ocular oncologist discussed considerations for promoting mental, physical, and visual adjustment across the course of UM survivorship. The control group received an enhanced treatment as usual manipulation comprised of a mental health resource information sheet. Participants completed four study visits via online surveys, including a baseline visit (T0) during which they completed assessments and were randomized to the intervention (n = 53) or control (n = 48) condition and received their respective study manipulations. Assessments were repeated one (T1) and two (T2) weeks later, with a final assessment (T3) administered four weeks after the third study visit. I hypothesized that participants randomized to the treatment condition would evidence less threatening illness perceptions over the course of the study than would participants in the control condition. Results: Multilevel models tested interactions between study condition and time to evaluate treatment effects on illness perception and psychological distress outcomes. Number of years since UM diagnosis and pre-randomization levels of approach- and avoidance-oriented coping were included in separate models as moderators. No interactions between study condition and time were statistically significant (with or without additional moderator variables). Participants’ feedback suggested that both the psychoeducational and control interventions were rated as informative, acceptable, and credible. Participants reported that both interventions would have been particularly helpful at the time of UM diagnosis. Conclusion: We recommend that future trials test the psychoeducational intervention at more specific and relevant clinical milestones to optimize desired changes in illness perceptions (e.g., following UM diagnosis)
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Project Connect Online: Mediators of an Internet-based Psychosocial Intervention for Women with Breast Cancer
Full text linkPURPOSE: Many interventions have been designed to promote psychological adjustment during and following cancer diagnosis and treatment; however, notably few studies have specified the mediating processes through which these interventions work. The primary aim of this research is to examine theoretically and empirically grounded mediators of a web-based psychosocial intervention for women with breast cancer. METHODS: Women (N = 88) diagnosed with breast cancer (any stage, any time since diagnosis) were randomly assigned to participate in a three-hour workshop for hands-on creation of personal websites. Mediating variables were assessed at baseline, one month and six months following randomization, and dependent variables were assessed at baseline and six months following randomization. Indirect effects were tested using single and multiple mediator models.RESULTS: Relative to control participants, women randomized to Project Connect Online (PCO) evidenced significant benefit six months later on depressive symptoms, positive mood, and life appreciation, but not negative mood, perceived strengthened relationships, or intrusive thoughts. Change in coping self-confidence, loneliness, and social support from friends mediated the relationship between the intervention and improvement in depressive symptoms. Coping self-confidence mediated the relationship between the intervention and enhanced positive mood, and social support from friends mediated the relationship between the intervention and increased life appreciation. The intervention did not produce a significant change in the hypothesized mediator of self-reported emotional processing/expression. CONCLUSIONS: Findings indicate how PCO promoted adaptive change and highlight modifiable factors, including coping self-confidence, loneliness, and social support from friends, which contributed to positive adjustment to breast cancer. Examination of why emotional processing/expression was not associated with change in outcome variables suggests possible additional mediators of the treatment effect and ways in which the intervention can be enhanced
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Project Connect Online: Improving Psychosocial Adjustment for Women with Breast Cancer with an Internet-Based Intervention
Full text linkOBJECTIVE: Emotional expression and receipt of social support can promote psychological and physical health in women diagnosed with breast cancer. Communication between breast cancer patients and their social network can be challenging, however. Study 1 of the current research aimed to characterize the experience of women who participated in the intervention arm of Project Connect Online (PCO), a randomized controlled trial for breast cancer patients to create personal websites to facilitate emotional expression and communication with supportive others. Study 2, a comparative effectiveness trial of PCO for women with metastatic breast cancer (MBC), examined the potential psychosocial and physical health-related benefits of sharing personal websites with other MBC patients, family, and friends (PCO PLUS condition) versus sharing with family and friends only (PCO ONLY condition). METHODS: Study 1 examined the 46 women in the intervention arm of PCO, a three-hour workshop for creation of personal websites with a journal function. Participants completed assessments at baseline, one month, and six months. In Study 2, 30 women with MBC were randomly assigned to PCO PLUS (n = 14) or PCO ONLY (n = 16) and attended a similar workshop. General and cancer-specific psychosocial and physical functioning was assessed at baseline, two months, and four months. Multilevel models examined comparative effectiveness of the two conditions, potential mediating variables, and predictors of change in outcomes. RESULTS: Women in Study 1 found the websites useful for telling the story of their experience and expressing emotions. Greater use of positive and negative emotion words on the websites was associated with improved psychological functioning at six months. Women with advanced cancer were more likely to use their websites than women with early-stage disease. In Study 2, significant increases in life appreciation, MBC-related altruism, and cancer-related physical symptoms and worsening physical functioning were observed across conditions. Anxiety decreased significantly in PCO PLUS and did not change in PCO ONLY. No significant mediated effects of PCO PLUS versus PCO ONLY on outcomes were observed. CONCLUSIONS: Personal websites can help women with breast cancer, and, in particular, MBC, construct a narrative of their experience and receive support. For women with MBC, personal websites to communicate with family and friends may improve cancer-specific psychosocial adjustment. Communicating with other MBC patients via personal websites, even infrequently, may confer additional psychosocial benefits
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Emotional Expression and Positive Affect in Latina and non-Latina White Women Coping with Chronic Financial Stress
Full text linkThe aim of this dissertation was to examine emotional expression and positive affect in a sample of Latina and non-Latina white female undergraduate students at UCLA experiencing chronic financial stress. In order to assess the influence of dispositional emotional tendencies, stressor-specific coping, and cultural factors on outcomes of induced emotional expression, the first study examined the main and moderated effects of induced emotional expression on depressive symptoms, intrusive thoughts, negative affect, and positive affect. The second study examined a unifying model in order to elucidate possible pathways by which positive affect is sustained over time in the context of chronic stress through its relationship with dispositional emotional tendencies and stressor-specific coping. Method: After being screened to establish at least moderate chronic financial stress, women (N = 136) were randomly assigned to discuss the emotions regarding their financial stress (induced emotional expression) or the facts regarding their finances (control) during two laboratory sessions. Depressive symptoms, intrusive thoughts, negative and positive affect were assessed at baseline and one- and ten-week follow-ups. Study 1 Results: Multilevel modeling analyses demonstrated that approach-oriented dispositional and stressor-specific processes predicted better psychological adjustment over time, whereas avoidance-oriented processes predicted greater distress over time. Stressor-specific coping self-efficacy uniquely predicted better psychological adjustment across all four outcomes. There was no significant main effect of condition; however, the effect of condition was moderated by dispositional and stressor-specific factors. Induced emotional expression predicted lower distress across time than the control condition at high levels of avoidance processes and predicted greater positive affect across time than the control condition at low, mean, and high levels of stressor-specific coping self-efficacy and approach processes, with the magnitude of this effect increasing at higher levels of these processes. Study 2 Results: Path model analyses demonstrated that dispositional emotional acceptance and reflection were associated with higher baseline positive affect, which in turn was associated with greater stressor-specific coping self-efficacy. Both baseline positive affect and stressor-specific coping self-efficacy predicted greater positive affect at one week, which subsequently predicted greater positive affect at ten weeks. Conclusions: Findings suggest that induced emotional expression both counteracts engagement in avoidance-oriented processes to reduce distress and capitalizes on stressor-specific coping self-efficacy and approach-oriented processes to increase positive affect. Furthermore, stressor-specific coping self-efficacy predicts better psychological adjustment across time and specifically plays a role in the sustenance of positive affect over time in the context of chronic stress. Taken together, the two studies underline potential benefits associated with stressor-specific coping self-efficacy in young women coping with chronic financial stress and suggest that it may be a good target for intervention
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