A pilot randomized controlled trial of cognitive bias modification to reduce fear of breast cancer recurrence.

BACKGROUND: The most common, persistent concern among survivors of breast cancer is the fear that their disease will return, yet to the authors' knowledge, few interventions targeting fear of cancer recurrence (FCR) have been developed to date. The current pilot study examined the feasibility, acceptability, and preliminary efficacy of a home-delivered cognitive bias modification intervention to reduce FCR. The intervention, called Attention and Interpretation Modification for Fear of Breast Cancer Recurrence (AIM-FBCR), targeted 2 types of cognitive biases (ie, attention and interpretation biases). METHODS: A total of 110 survivors of breast cancer were randomized to receive 8 sessions of 1 of 2 versions of AIM-FBCR or a control condition program. Computer-based assessments of cognitive biases and a self-report measure of FCR were administered before the intervention, after the intervention, and 3 months after the intervention. RESULTS: Improvements in health worries (P = .019) and interpretation biases (rates of threat endorsement [P<.001] and reaction times for threat rejection [P = .007]) were found in those survivors who received AIM-FBCR compared with the control arm. Although only 26% of participants who screened into the study agreed to participate, the trial otherwise appeared feasible and acceptable, with 83% of those who initiated the intervention completing at least 5 of 8 sessions, and 90% reporting satisfaction with the computer-based program used. CONCLUSIONS: The results of the current pilot study suggest the promise of AIM-FBCR in reducing FCR in survivors of breast cancer. Future research should attempt to replicate these findings in a larger-scale trial using a more sophisticated, user-friendly program and additional measures of improvement in more diverse samples. Cancer 2017;123:1424-1433. © 2016 American Cancer Society.

Bereavement Follow-Up After the Death of a Child as a Standard of Care in Pediatric Oncology.

After a child's death to cancer, families commonly want continued connection with the healthcare team that cared for their child, yet bereavement follow-up is often sporadic. A comprehensive literature search found that many bereaved parents experience poor psychological outcomes during bereavement and that parents want follow-up and benefit from continued connection with their child's healthcare providers. Evidence suggests that the standard of care should consist of at least one meaningful contact between the healthcare team and bereaved parents to identify those at risk for negative psychosocial sequelae and to provide resources for bereavement support.

Visible ink: A flexible and individually tailored writing intervention for cancer patients.

OBJECTIVES: Subjective reports on the effectiveness of and satisfaction with writing interventions in medical populations have indicated that they can have a profound impact on patients. Further, past research on these programs has demonstrated that they can lead to a number of different positive outcomes depending on the personal characteristics of the participating patients and the type of writing with which they are tasked. For this reason, a flexible and individually tailored writing intervention may be particularly effective for patients, molding its approach to their desires and backgrounds. This paper examines Visible Ink, a writing program for cancer patients at Memorial Sloan-Kettering Cancer Center (MSKCC) that follows this model. METHODS: At Visible Ink's First Fall Writing Festival in November 2012, an optional survey was provided to all program participants in attendance, capturing both quantitative and qualitative information on patient experiences in the program. Twenty-nine surveys were completed. RESULTS: The program appears to have a variety of positive effects, including fostering personal growth and providing a positive distraction. Respondents reported that they write in a number of different genres on topics both related and not related to their illnesses, which supports the flexible model of the program. All respondents indicated that they would recommend the program to others, and satisfaction with the program's general approach (i.e., individualized work with a writing coach) was unanimous. A few areas for potential improvement were also identified, most of which involved expanding the services and events offered by the program. SIGNIFICANCE OF RESULTS: Despite the limitations of this survey (e.g., small sample size and low response rate), its results support the promise of the Visible Ink model and demonstrate participants' satisfaction with the program. Future research can more thoroughly examine Visible Ink's effectiveness, and additional resources could enable the program to expand.

Prognostic awareness and communication of prognostic information in malignant glioma: a systematic review.

Malignant glioma (MG) is a devastating neurological disease with a uniformly poor prognosis and a clinical course characterized by progressive functional and cognitive impairment. A small body of literature addresses patients' and caregivers' prognostic awareness (PA), or understanding of prognosis in patients with cancer. Studies that examine PA and desire for prognostic information among patients with MG are limited. We sought to review the existing literature on PA and communication of prognostic information to patients with MG. Fourteen studies examining PA or experience and preferences regarding communication of prognostic information were included. The definition and measurement of PA across studies varied, and the prevalence of accurate PA ranged from 25 to 100 % of participants. There is likely a subset of patients who do not desire accurate prognostic information, although the patient and disease characteristics that predict this preference are currently unknown. This review suggests that patients with MG desire prognostic information communicated in a manner that preserves hope. Systematic investigation to define communication needs for prognostic information in the unique clinical setting of MG is needed.

What do parents want to know when considering autopsy for their child with cancer?

Research has suggested that autopsy in pediatrics is a valued way for parents to better understand and process their child's death, yet physicians often express hesitancy in discussing this topic with parents. To better assist clinicians with initiating discussion about this often sensitive topic, the current study examined bereaved parents' preferences about the timing and content of the autopsy discussion as well as reasons for considering autopsy. This study explored the views of 30 parents who lost a child to a variety of malignancies between 6 months and 6 years ago. Results showed that 36.7% of parents recalled having a discussion about autopsy, and the vast majority of those who did not recall a discussion (89.5%) would have considered an autopsy if it had been discussed. The majority of participants in this study indicated their preference to have the first conversation about autopsy when it becomes clear that cure is no longer possible. Findings suggest that educating parents about the clinical, emotional, and potential research benefits of autopsy and tissue procurement will ultimately help them make informed decisions and understand the importance of autopsy in medical progress. The future research and clinical implications of these findings are discussed.

Social contributions to meaning in life: the role of romantic relationship quality, parenting, and gender.

Introduction: The present study tests the association between romantic relationship quality and number of children on meaning in life (i.e., sense of purpose, coherence, and significance) and considers interactions between these constructs and gender. Methods: A survey was conducted approximately one year into the pandemic among 473 individuals in the United States. Results: Models demonstrated that relationship quality and number of children are positively associated with meaning, though relationship quality was more strongly related to meaning for men than women. We showed that for women there was an equally positive link between relationship quality and meaning regardless of number of children. However, for men, the positive association between relationship quality and meaning was strongest for those with more than one child, decreased in magnitude for those with one child, and was no longer significant for men with more than one child. Discussion: These findings provide empirical evidence that social relationships benefit meaning in life and underscore the complexity of these associations. Results have implications for theoretical perspectives on meaning in life, as well as for policies that encourage family wellbeing.

Loss during COVID-19: Moderating effects of meaning and romantic relationships on anxiety and depressive symptoms.

OBJECTIVE: The COVID-19 pandemic exacerbated experiences of loss and grief for many individuals and posed a challenging mental health crisis. Compared to studies examining a singular type of loss, the present study investigated the cumulative impacts of COVID-related losses on anxiety and depressive symptoms and examined whether meaning in life, marital status, or relationship quality offered a protective moderating role. METHOD: A cross-sectional online survey was conducted approximately 1 year into the pandemic among 434 diverse individuals (32.0% White; 52.1% women; Mage = 34.7) in the United States. Measures included: General Anxiety Disorder-7, Patient Health Questionnaire-9, Quality of Marriage Index, and 26 loss items with corresponding grief ratings. RESULTS: Results using linear mixed models demonstrated strong positive links between loss and both anxiety and depressive symptoms, although the association between loss and anxiety was stronger for women. The association between loss and anxiety was attenuated at high levels of meaning in life compared to average and low levels of meaning and for married individuals compared to unmarried participants. Being married also buffered the impact of loss on depressive symptoms. CONCLUSIONS: Findings indicate that cumulative pandemic-related loss is associated with anxiety and depressive symptoms, and that meaning in life and romantic relationships may be promising interventional targets; though, these findings may change over the course of the pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The birth of a story: Childbirth experiences, meaning-making, and postpartum adjustment.

The present study investigated how meaning-making around a birth experience predicts relationship quality and parenting stress across the transition to first-time parenthood, a time that many new parents find stressful and challenging. Childbirth experiences may set the stage for these challenges, and how new parents make meaning of childbirth could play a role in their subsequent postpartum adjustment. Meaning-making processes (sense making, benefit finding, and changes in identity) were coded from birth narratives collected from 77 mixed-sex biological parent dyads (n = 154 individuals) shortly after the birth of their first child. Parents reported on their relationship quality during pregnancy and at 6 months postpartum, and on their parenting stress postpartum. Mothers' greater sense making and benefit finding buffered longitudinal declines in their own relationship quality, and maternal sense making also buffered declines for fathers. Fathers' greater sense making and benefit finding predicted lower levels of their own parenting stress, whereas mothers' greater sense making and benefit finding were linked with higher paternal parenting stress. Finally, fathers' discussion of changes in identity predicted lower levels of parenting stress in mothers. These results suggest the importance of meaning-making following childbirth for couples adjusting to parenthood and highlight the value of studying meaning-making processes dyadically. Clinicians may be able to support new parents by facilitating their coconstruction of meaning during their shared birth experience and transition to parenthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

What happens when romantic couples discuss personal loss? Relational, emotional, and physiological impacts.

Does talking about loss with a romantic partner have salutary personal and relationship effects? Prior evidence reveals the benefits of emotional disclosure in couple relationships, yet disclosure about loss has been overlooked in research on couple communication. Using a novel communication paradigm with young-adult heterosexual romantic partners (N = 114 couples), we investigated emotions, physiological arousal (skin conductance responses [SCR]), and relationship closeness when narrating a personal loss and listening to the partner's loss, and compared these loss discussions to discussions about desired relationship changes. Based on partners' self-reports, narrating loss elicited more vulnerable and, unexpectedly, more antagonistic emotions. Both narrating and listening to loss produced higher self-reported partner closeness, compared to discussing change. In support of the physiological benefits of disclosure, women's SCRs decreased over the discussion when they narrated their own loss. However, both women and men as listeners show a general trend of increasing SCRs over the discussion, suggesting the challenges of being a responsive partner. Moreover, in line with the putative protective effects of partners' biological interdependencies, partner closeness also was higher when both partners showed synchronous decreasing SCR as women narrated their loss. Although limited to young couples in relatively short relationships, these findings reveal some potential benefits of talking about loss in the context of romantic relationships. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Physiological linkage in pregnancy: Couples' cortisol, negative conflict behavior, and postpartum depression.

Within-couple concordance in momentary cortisol levels ("cortisol linkage") may reflect meaningful relationship dynamics. In this study, we examined couple cortisol linkage during pregnancy, associations with negative conflict couple behavior, and subsequent postpartum depressive symptoms. Eighty-two opposite-sex couples expecting their first child engaged in a conflict discussion, provided six salivary cortisol samples over the course of a laboratory visit, and then reported on depressive symptoms six months after their baby's birth. Couples' cortisol levels were significantly positively associated with each other, indicating linkage. When mothers and fathers behaved less negatively during the prenatal conflict discussion, they exhibited stronger couple cortisol linkage. Stronger cortisol linkage also predicted fewer postpartum depressive symptoms for fathers. Negative conflict behavior did not moderate the association between cortisol linkage and postpartum depression. These findings suggest that stronger physiological associations between partners during pregnancy may reflect healthier relationship interactions and be beneficial to fathers' postpartum mental health.

Young adult couples' behavioral and physiological responses to the infant simulator: A preliminary illustration of coparenting.

This exploratory application of the infant simulator with two couples is designed to illustrate individual reactivity and coparenting behaviors in young couples in serious relationships who do not yet have children. A 35-min protocol with standardized onsets and offsets of inconsolable baby cries was used to capture partner's individual behavioral and physiological responses as well as the couple's joint efforts to soothe the crying baby. Task feasibility was demonstrated by couples' persistent and wide-ranging efforts to calm the baby including rocking, feeding, changing, talking to the baby, and singing. Within-person fluctuations in ongoing heart rate (HR) and electrodermal activity (EDA) through the protocol suggested evidence of heightened physiological reactivity during baby crying compared to silence. During bouts of crying, higher HR also was evidenced when participants took the lead in caregiving as contrasted with assisting or busying themselves in another task. Behavioral observations indicated that this task elicited examples of coparenting behaviors including cooperation, support, undermining, and negotiating the division of labor. These preliminary pilot data demonstrate the potential of infant simulator paradigms with couples who are not yet pregnant but envision being future parents, and set the stage for future research to identify how individual and couple characteristics might impact reactions to shared baby caregiving.

The weight of fatherhood: identifying mechanisms to explain paternal perinatal weight gain.

Men appear to gain weight during the transition to parenthood, and fathers are heavier than non-fathers. Paternal perinatal weight gain may set weight trajectories in midlife and have long-term health implications. Since men do not undergo the physical demands of pregnancy and breastfeeding, the specific mechanisms underlying weight gain in new fathers warrant investigation. This review aims to stimulate research on paternal perinatal weight gain by suggesting testable potential mechanisms that (1) show change across the transition to parenthood and (2) play a role in weight and body composition. We identify seven mechanisms, within three categories: behavioural mechanisms (sleep, physical activity, and diet), hormonal mechanisms (testosterone and cortisol), and psychological mechanisms (depression and stress). We also discuss direct effects of partner pregnancy influences (e.g., 'couvade syndrome') on men's body weight. In presenting each mechanism, we discuss how it may be affected by the transition to parenthood, and then review its role in body composition and weight. Next, we describe bidirectional and interactive effects, discuss timing, and present three broad research questions to propel theoretical development.

Mental Health Services for Parents Who Lost a Child to Cancer: If We Build Them, Will They Come?

PURPOSE: To examine bereavement mental health service use, barriers to use, and factors associated with use in parents bereaved by cancer. PATIENTS AND METHODS: A multicenter, cross-sectional study of 120 parents bereaved by cancer between 6 months and 6 years after their loss was performed. Parents completed self-report assessments of mental health service use and barriers, prolonged grief, depression, anxiety, attachment styles, and sense of meaning by phone, in person, or on their own. RESULTS: Forty-one percent of bereaved parents were currently using mental health services (talk therapy, psychotropic medication, and/or a support group), most commonly within the first 2 years after their loss. Talk therapy was the most frequently used service, although 36% of parents who discontinued therapy did so because it was not helpful. Forty percent of parents who wanted bereavement support reported they were not receiving services. The most common barriers to service use were that it was too painful to speak about the loss (64%) and too difficult to find help (60%). Factors associated with current mental health service use included more recent loss, prior mental health service use, subclinical/increased depression, insecure attachment styles, and a decreased sense of meaning. Minority parents were more likely to have unmet needs than nonminority parents. CONCLUSION: Parents appear to need, want, and often access bereavement mental health services, which could be offered in oncology settings. However, barriers to service use must be addressed, particularly for those with more debilitating grief symptoms and for minorities. High treatment dropout rates suggest the importance of improving retention, training providers, and developing effective grief interventions.

Sharing a diagnosis of HPV-related head and neck cancer: the emotions, the confusion, and what patients want to know.

BACKGROUND: Oropharyngeal cancers are increasingly associated with human papillomavirus (HPV). Little is known about the experience of patients receiving this diagnosis. METHODS: Semistructured interviews were conducted with ten survivors of HPV-related oropharyngeal cancer. The interviews were transcribed, and recurring themes were identified. RESULTS: Physicians were a trusted source of information regarding HPV. Framing the diagnosis in terms of prognosis resonated with patients. The uncertainty about transmission, latency, and communicability colored the dialogue about HPV. Despite some understanding of prevalence and transmission, patients worried about their partner's risk. Patients sought information about HPV on the Internet, but it was not easily navigable. Emotional reactions to the diagnosis remained mostly cancer-centric rather than HPV-centric. A patient-education handout was developed in response to patient questions. CONCLUSIONS: Additional educational resources explaining the facts about HPV in HNSCC in a consistent way including content of highest priority to patients may improve understanding of HPV.