Psychological group intervention to support parenting: Qualitative study about needs and preferences of mothers with breast cancer.

PURPOSE: Parental worries and parenting stress can increase when a mother receives a breast cancer diagnosis. This study presents the findings of needs and preferences of mothers with breast cancer to inform the development of a group intervention program for mothers with breast cancer and other alternatives of support. METHODS: Using qualitative data from eighteen Portuguese women with at least one minor child when they received a breast cancer diagnosis, and content analysis on three focus groups transcripts, we uncover the participants' parenting needs and their perceptions of the potential benefits and the formal aspects of a group intervention. RESULTS: Mothers revealed that they need support on several parenting-related issues (e.g., communicating with the children about the mother's diagnosis, dealing with children's responses and difficult questions). They provided information about the potential benefits of group intervention and preferences regarding intervention content, sessions' structure, frequency, location, and timing. Some participants also suggested other types of support, such as online information and individual psychological support. CONCLUSIONS: The development of an intervention informed by the patients' needs and preferences can contribute to increasing its feasibility and efficacy. The findings indicated the specific parenting needs of Portuguese mothers with breast cancer, and it offered health professionals some important clues on how to support other family members.

Communication concerns in mothers with cancer: Development and psychometric properties of a new measure.

OBJECTIVE: This study aimed to present the development of the Communication Concerns in Parents with Cancer Scale (CCPCS) and to evaluate its psychometric properties in mothers with cancer. METHODS: Two hundred and twenty-nine mothers with cancer participated in this study. Participants reported on parenting concerns, depressive and anxiety symptoms and quality of life. An exploratory factor analysis (EFA) was performed to explore the factor structure of the new scale. Concurrent and convergent validity, internal consistency and test-retest reliability were evaluated/obtained. To measure invariance according to type of cancer and time passed since diagnosis, a multi-group analysis was used. RESULTS: EFA suggested that the scale comprised one factor that explained 75.63% of the total variance. The developed CCPCS had high internal consistency. Communication concerns were positively associated with other parenting concerns, as well as anxiety and depression symptoms. Test of measurement invariance showed scalar invariance for type of cancer, and residual invariance for time passed since diagnosis. CONCLUSION: The CCPCS seems to be a promising scale to measure communication concerns in mothers with cancer for clinical and research purposes. Knowing the impact of communication concerns in the mother's process of adaptation to cancer can provide clues for the psycho-oncological care offered.

Distress facing increased genetic risk of cancer: The role of social support and emotional suppression.

OBJECTIVES: Healthy individuals from hereditary cancer families undergoing genetic testing for cancer susceptibility (GTC) report more distress when they perceive their social support as low and suppress their emotions. This study aimed to explore how suppressing emotions and perceiving others as unsupportive are related with cancer-risk distress. METHODS: We performed a regression-based mediation analysis to assess if expressive suppression mediates or is mediated by perceived social support in the relation with cancer-risk distress. Participants were 125 healthy adults aged over 18 (M = 36.07, SD = 12.86), mostly female (72,4%), who undergone GTC to assess the presence of hereditary breast and ovarian cancer or Lynch syndromes. RESULTS: Controlling for age and gender, we found a moderate size indirect effect of social support on cancer-risk distress through expressive suppression (ß = -0.095) and a direct effect of expressive suppression on cancer-risk distress. CONCLUSIONS: When healthy individuals from hereditary cancer families perceive their social network as less responsive, they tend to not express their emotions, which relates to increased distress facing GTC. PRACTICE IMPLICATIONS: Practitioners may assess cancer-risk related distress before the GTC and offer distressed individuals interventions focused on changing emotion regulation strategies in a safe group context.

Family Adjustment to Hereditary Cancer Syndromes: A Systematic Review.

Hereditary cancer syndromes are inherited pathogenic genetic variants that significantly increase the risk of developing cancer. When individuals become aware of their increased probability of having cancer, the whole family is affected by this new reality and needs to adjust. However, adjustment to hereditary cancer syndromes has been mainly studied at an individual level, and research about familial adjustment remains dispersed and disorganized. To overcome this gap, this review aims to understand how families adjust to genetic testing and risk management, and to what extent the family's adjustment influences the psychological response and risk management behaviors of mutation carriers. We conducted searches on the PubMed/Med Line, PsycInfo, SCOPUS, and Google Scholar databases and used the Mixed Methods Appraisal Tool (MMAT-v2018) to assess the methodological quality of each selected study. Thirty studies met the inclusion criteria. Most results highlighted the interdependent nature of adjustment of pathogenic variant carriers and their families. The way carriers adjust to the syndrome is highly dependent on family functioning and related to how family members react to the new genetic information, particularly partners and siblings. Couples who share their worries and communicate openly about cancer risk present a better long-term adjustment than couples who use protective buffering (not talking about it to avoid disturbing the partner) or emotional distancing. Parents need help dealing with disclosing genetic information to their children. These findings reinforce the importance of adopting a family-centered approach in the context of genetic counseling and the necessity of involving family members in research.

Parental meta-emotion, attachment to parents, and personal agency in adolescents.

Guided by attachment theory, we explored in the present study the links between parental emotion-coaching, attachment to parents, and adolescent's sense of agency. Further, we examined a possible mediating role of adolescent's attachment to parents in the association between parental emotion-coaching and sense of agency. All models control for cumulative psychosocial risk, and adolescents' sex and age, and take into account the reports of both mothers and fathers. The sample included 501 Portuguese families comprising adolescents, their mothers, and their fathers. Adolescents (ages ranged from 15 to 18) reported on their attachment to parents, personal agency, and cumulative psychosocial risk, whereas mothers and fathers independently completed a questionnaire assessing their meta-emotion skills. The results indicate that both mothers' and fathers' emotional-coaching are positively associated with the quality of adolescent's attachment to parents. Nonetheless, parental emotion-coaching are not directly associate with sense of agency. The quality of emotional bond with father is linked to a more positive sense of agency, while relationships characterized by mother's inhibition of adolescent's exploration are associated with less positive perceptions of agency. Parental emotion-coaching seems to be associated with the sense of personal agency through the quality of attachment to parents. These results are discussed according to attachment theory taking into account the parents' importance to adolescents' development. Our findings provide a first attempt to unravel the possible links between parental emotion-coaching, attachment to parents, and sense of agency; nevertheless, they need to expand. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

We stick together! COVID-19 and psychological adjustment in youth residential care.

BACKGROUND: Children and youth residential care institutions were forced to introduce adaptations to their regular functioning in order to respond to the COVID-19 pandemic challenges. OBJECTIVE: The purpose of this study was to examine the effects of the lockdown on the adolescents' psychological adjustment and whether adolescents' perceived cohesion mitigated the increase of adolescents' psychological adjustment problems. PARTICIPANTS: Participants were 243 adolescents aged 12 to 18 years, living in 21 different residential care institutions. RESULTS: The results suggested a moderating role of cohesion on the stability of adolescents' emotional distress across time. Lower levels of cohesion were related with higher emotional distress stability across time. On the contrary, as cohesion increased, the association between adolescents' emotional distress at T0 and T1 decreased. DISCUSSION: Results are discussed considering the mechanisms raised by the institutions to respond to the COVID-19 pandemic and minimize the negative effects on the psychological adjustment of adolescents living in residential care.

Teacher-child dependency in preschool: links with teacher-child closeness, conflict and children's effortful control.

Dependency is a scarcely investigated dimension of teacher-child (T-C) relationships that can reflect a lack of security and obstruct children's autonomous exploration in the school context. We examined the within- and cross-time associations between T-C dependency, closeness, and conflict, and children's effortful control, an ability related to children's self-regulation. Data were collected during the preschool period at two time-points (T1 and T2) 1-year apart. Participants were 199 children (44% girls, M age = 47.47) attending 46 middle-class preschool classrooms. Results from path analyses indicated that, though marginally significant, there was a positive association between T-C dependency and conflict at T1. At T2, dependency was positively related to both conflict and closeness. Dependency at T1 positively predicted children's effortful control at T2. This study clarifies the interconnection between T-C dependency, closeness and conflict, and the unique contribution of dependency onchildren's effortful control. Findings are discussed considering the socio-cultural meaning of dependency.

Validation of a Portuguese Version of the Aspiration Index for Adolescents (AI).

Intrinsic and extrinsic types of motivation have been widely studied, and their importance on both developmental and educational practices has led to the development of assessment tools. The Aspiration Index scale (AI; Grouzet et al., 2005), which was developed to measure people`s life aspirations, was translated and validated into Portuguese. A sample of 1,359 adolescents, age ranged from 12 to 18 years-old, participated in the present study. Results showed that a factor structure with the eleven subscales of the AI does not fit the data. However we gathered support for a three-factor structure that organized the items in terms of whether aspirations are intrinsically, extrinsically or self-transcendent oriented. Internal consistency and temporal stability yielded good results. The predictive and criterion validities were demonstrated by significant associations with theoretically supported measures of satisfaction with life and father and mother attachment. The multi-group confirmatory factor analysis showed that this structure was invariant across gender. These results suggest that the AI is a reliable measure to assess different types of life aspirations and can be used in future research with adolescents in Portugal.

The Parenting Concerns Questionnaire: A validation study with Portuguese parents with cancer.

OBJECTIVES: To examine the psychometric properties of the Parenting Concerns Questionnaire (PCQ) in a sample of Portuguese parents with cancer. METHODS: The PCQ was completed by 209 adults with cancer, who are parents of at least one minor child. Participants reported on parenting concerns, depressive and anxiety symptoms, parental stress as well as quality of life. Confirmatory factor analysis and Item Response Theory (IRT) were used to assess the psychometric properties of the PCQ. Cronbach's alpha was used to examine its reliability. Pearson correlation coefficients provided information regarding convergent validity. Criterion validity was analysed. RESULTS: Confirmatory factor analysis confirmed the original three-factor structure. IRT indicated that most of the items were highly discriminant and better identified as moderate versus low or high levels of parenting concerns in the three dimensions of PCQ. The pattern of associations with depressive and anxiety symptoms, parental stress, and quality of life provided evidence for the convergent validity. The PCQ differentiated between parents with and without depressive symptoms. CONCLUSION: Exploring parenting concerns provides additional relevant information about the experiences and the potential psychological distress experienced by these parents with cancer. The PCQ can be an important tool to identify parents with cancer who might benefit from psychological support regarding parenting.

Attachment, emotion regulation, and well-being in couples: Intrapersonal and interpersonal associations.

OBJECTIVE: There is a well-established link in the literature between secure romantic attachment orientation and psychological well-being. The underlying processes of this link and the couple interplay between attachment and well-being are notably less explored. Using a dyadic framework, this study examines both couple members' emotion regulation strategies as potential mediators of this link. METHOD: One hundred and nineteen heterosexual couples completed self-report measures on attachment style, psychological well-being, tendency to suppress emotions, and emotion expression. Analyses were performed using the actor-partner interdependence mediation model that distinguishes between intrapersonal and interpersonal influences. RESULTS: Results showed that controlling for relationship length, there was an intrapersonal indirect effect of attachment avoidance on psychological well-being through emotion suppression. Moreover, interpersonal indirect effects were found (a) with individual attachment avoidance being associated with partner's psychological well-being through own emotion expression and (b) individual's attachment anxiety being associated with partner's psychological well-being through both own's emotion expression and partner's emotion suppression. CONCLUSIONS: These findings highlight the complex associations among attachment, emotion regulation, and well-being and point out the role of emotion regulation as a potential underlying pathway explaining these associations. The results suggest the importance of considering the relational nature of emotional and attachment dynamics in couples.

Elaboration of countertransference experience and the workings of the working alliance.

Alliance may impact psychotherapy outcomes both as a precondition that enables therapeutic work and an evolving process that is therapeutic in itself. This study examined the participation of the elaboration of countertransference experience (ECE) in alliance variation between therapist-client dyads early in therapy and within dyads over time. A total of 44 session assessments nested within 12 dyads were modeled through longitudinal multilevel analyses and utilized to examine the associations between the ECE dimensions of Immersion and Reflection and alliance components across 4 time points within the first 10 sessions of psychotherapy. Results supported the importance of initial ECE to explain differences in alliance between dyads, the particular relevance of ECE with clients presenting lower levels of personality organization, and the effect of personality difficulties on alliance change. Unexpected results were found concerning the correlations between ECE and alliance and their covariation over time. In conclusion, ECE dimensions appear to be involved in alliance formation, both in initial differences between dyads and in changes over time within the same case. ECE seems particularly important with more personality-disturbed clients. Future research should disentangle therapist and client contributions and examine the participation of ECE in the resolution of alliance ruptures. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

How Routine Patient-Centered Monitoring Relates to Therapeutic Gains in Family Therapy: A Single-Case Study.

As routine outcome monitoring systems develop, questions emerge about how therapists incorporate feedback into their practice, and how this relates to therapeutic gains. A case of covert grief was monitored in each session with the Personal Questionnaire and the Helpful Aspects of Therapy instruments. At 4 months follow-up, the Change Interview was administered. Individualized items facilitated access to the private views and needs of each member, which was useful for case formulation and ongoing personalization of the intervention. Qualitative feedback of treatment experiences helped therapists confirm the impacts of interventions, monitor therapeutic alliance, reformulate clinical hypothesis, and plan sessions. Therapists followed a critical triangulation process to decide the clinical meaning of feedback, according to his/her intervention model, expertise, and case-specific context.

Mentalizing countertransference? A model for research on the elaboration of countertransference experience in psychotherapy.

As a construct, the elaboration of countertransference experience (ECE) is intended to depict the implicit and explicit psychological work to which therapists submit their experiences with clients. Through ECE, defined as a mentalizing process of a particular kind, therapists' experiences are presumed to acquire and increase in mental quality and become available for meaning-making and judicious clinical use. In this paper, we claim that such an ongoing process facilitates engagement with common therapeutic factors, such as the therapeutic alliance and countertransference management, enhancing therapist responsiveness in psychotherapy. We synthesize relevant literature on countertransference, mentalization, and, in particular, therapists' mentalization, informed by a systematic literature review. As a result, we propose a model for assessing ECE in psychotherapy, comprising 6 diversely mentalized countertransference positions (factual-concrete, abstract-rational, projective-impulsive, argumentative, contemplative-mindful, and mentalizing), 2 underlying primary dimensions (experiencing, reflective elaboration), and 5 complementary dimensions of elaboration. Strengths and limitations of the model are discussed.

Trajectories of parental engagement in early childhood among dual-earner families: Effects on child self-control.

Parental engagement in positive activities with the child may show significant variation across time, assuming a crucial influence on child development. In dual-earner families, work-family conflict can interfere with parental engagement, with negative consequences for children's behavior. The current study examined the change trajectories of mothers' and fathers' engagement in early childhood, analyzing whether these trajectories are influenced by parents' work-family conflict and whether they predict child behavioral self-control. Data from 156 four-year-old children (67 girls) from dual-earner families were collected annually for 3 consecutive years, through mothers', fathers', and teachers' reports. Results from latent growth curve analysis revealed mothers' engagement remained stable across time while fathers' engagement had a significant increase over time. The negative association between work-family conflict and parental engagement was constant over time both for mothers and fathers. For mothers, initial levels of engagement positively predicted child behavioral self-control. As for fathers, both the initial level and positive change in engagement positively predicted child self-control. These findings emphasize the role of parental engagement in fostering child behavioral adjustment, underlining the need for considering work-family dynamics to understand changes in parental engagement. (PsycINFO Database Record

Mothers with breast cancer: A mixed-method systematic review on the impact on the parent-child relationship.

OBJECTIVE: To systematically review and integrate the findings from quantitative and qualitative studies on parenting and parent-child relationships in families where mothers had breast cancer (BC). METHODS: Ten different databases were searched from inception to January 2016. All authors assessed these data independently. Full-text, peer-reviewed articles exploring parenting and/or mother-child relationships in families where the mother had BC, regardless of cancer stage, were considered for inclusion. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS: From 116 studies, 23 were deemed eligible for inclusion. Five of them were quantitative, 15 were qualitative, and 1 study used a mixed-method approach. Most studies analysed the mother's perceptions about the experience of having BC in parenting and in the parent-child relationship. The majority of studies explored experiences and perspectives on the parent-child relationship in mothers with minor children, although a minority of studies included adult children. Additionally, a few studies (17%) addressed perceptions and experiences of women with advanced stage cancer. Three main themes were found: priorities and concerns of patients, decision-making processes about sharing the diagnosis with their children, and mother-child relationship and parenting after mother's diagnosis. CONCLUSIONS: Findings indicated that the diagnosis of BC is accompanied by an array of challenges that affect parental roles and parenting. Further studies are needed to explore these issues more sensitively. For now, however, the evidence suggests that the families of women with BC, and particularly the women themselves, may benefit from informal and formal support aimed at helping them cope effectively with this challenging life event.

Marital adjustment in the context of female breast cancer: A systematic review.

OBJECTIVE: Breast cancer (BC) diagnosis and subsequent treatments present significant challenges and distress for both patients and their partners. This can lead to difficulties in marital relationships and, consequently, decreases in marital adjustment and psychosocial adaptation to BC for both partners. Our objective was to systematically review studies assessing marital adjustment in the context of female BC to understand which factors are associated with marital adjustment in both patients and partners and characterize the measures used to assess marital adjustment within these studies. METHODS: This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English, peer-reviewed articles exploring factors associated with marital adjustment in the context of female BC were considered for inclusion. RESULTS: Fourteen studies were included. Results evidenced that psychosocial variables play an important role on marital adjustment. Specifically, open and constructive communication, more social support, and supportive dyadic coping were found to be associated with higher levels of marital adjustment. Other variables such as self-efficacy, sexual functioning, and psychological adjustment were also positively associated with marital adjustment. CONCLUSIONS: Most studies evidenced an association between psychosocial variables and marital adjustment for both women and their partners. Some important dimensions such as communication patterns, coping strategies, and social support dynamics were identified as potential targets for psychological interventions. Some variables, however, were explored only in a few studies, which limit our conclusions. Future studies should explore the role these variables and other relational and emotional variables play in promoting marital adjustment after BC.

Psychological adjustment after breast cancer: a systematic review of longitudinal studies.

OBJECTIVES: Breast cancer (BC) can be a traumatic and stressful experience for women, but there are wide-ranging differences in the ways in which women respond and adapt to BC. This systematic review examines which sociodemographic, disease-related, and psychosocial factors near diagnosis predict later psychological adjustment to BC. METHODS: Database searches were conducted in 9 different health-related databases from 2000 to December 2015 using relevant search terms. Full-text, peer-reviewed articles in English that analyzed potential predictors of psychological adjustment in longitudinal studies were considered for inclusion. RESULTS: Of 1780 abstracts, 41 studies fulfilled inclusion criteria. Consistent sociodemographic and disease-related variable predictors of adjustment were income, fatigue, cancer stage, and physical functioning. Psychosocial factors, particularly optimism and trait anxiety, as well as perceived social support, coping strategies, and initial levels of psychological functioning, were found to be predictive of later depressive and anxiety symptoms, psychological distress, and quality of life for women with BC, in predictable ways. Other psychosocial variables, such as cognitive and body image factors, predicted psychological adjustment but were explored only by a few studies. CONCLUSIONS: The majority of studies showed a significant relationship between psychosocial factors and psychological adjustment. These results point to specific sociodemographic, disease-related, and psychosocial factors that can help to identify women at the time of diagnosis who are at risk for long-term psychological challenges so they can be referred for psychological support that targets their specific needs and can improve their quality of life and mood and decrease indicators of anxiety, depression, and psychological distress.

The Generalized Problematic Internet Use Scale 2: Validation and test of the model to Facebook use.

The main goals of the present study were to test the psychometric properties of a Portuguese version of the GPIUS2 (Generalized Problematic Internet Use Scale 2, Caplan, 2010), and to test whether the cognitive-behavioral model proposed by Caplan (2010) replicated in the context of Facebook use. We used a sample of 761 Portuguese adolescents (53.7% boys, 46.3% girls, mean age = 15.8). Our results showed that the data presented an adequate fit to the original model using confirmatory factor analysis. The scale presented also good internal consistency and adequate construct validity. The cognitive-behavioral model was also applicable to the Facebook context, presenting good fit. Consistently with previous findings we found that preference for online social interaction and the use of Facebook to mood regulation purposes, predicted positively and significantly the deficient self-regulation in Facebook use, which in turn was a significant predictor of the negative outcomes associated with this use.

Balancing clinical risk with countertransference management protects Alliance.

The working alliance has been recognized as a predictor of psychotherapy outcome across therapeutic orientations. Despite mixed findings regarding the effect of problem severity on the alliance formation, there is evidence suggesting that therapist factors may interfere in this association. This study examined how clients' baseline clinical features affected the early alliance and the possible role of therapists' countertransference management as a mediator. Thirteen therapeutic dyads were assessed at 2 different time points. Clients' clinical dimensions were assessed prior to the 2nd session, and therapists' countertransference management and clients' ratings of the alliance were measured after the 2nd session. Positive associations were found between clients' subjective wellbeing, social functioning, risk, and global psychological distress and countertransference management dimensions and total score. Empathy-based countertransference management suppressed the negative impact of clinical risk on alliance. Our findings suggest that clinical problems activate countertransference management, which in turn may buffer their negative effect on alliance.

The emotion regulation questionnaire in women with cancer: A psychometric evaluation and an item response theory analysis.

OBJECTIVE: Emotion regulation is thought to play an important role in adaptation to cancer. However, the emotion regulation questionnaire (ERQ), a widely used instrument to assess emotion regulation, has not yet been validated in this context. This study addresses this gap by examining the psychometric properties of the ERQ in a sample of Portuguese women with cancer. METHODS: The ERQ was administered to 204 women with cancer (mean age = 48.89 years, SD = 7.55). Confirmatory factor analysis and item response theory analysis were used to examine psychometric properties of the ERQ. RESULTS: Confirmatory factor analysis confirmed the 2-factor solution proposed by the original authors (expressive suppression and cognitive reappraisal). This solution was invariant across age and type of cancer. Item response theory analyses showed that all items were moderately to highly discriminant and that items are better suited for identifying moderate levels of expressive suppression and cognitive reappraisal. Support was found for the internal consistency and test-retest reliability of the ERQ. The pattern of relationships with emotional control, alexithymia, emotional self-efficacy, attachment, and quality of life provided evidence of the convergent and concurrent validity for both dimensions of the ERQ. CONCLUSION: Overall, the ERQ is a psychometrically sound approach for assessing emotion regulation strategies in the oncological context. Clinical implications are discussed.