Deconstructing therapeutic mechanisms in cancer support groups: do we express more emotion when we tell stories or talk directly to each other?

Studies indicate that story-telling and emotional expression may be important therapeutic mechanisms. This study examined how they work together over 1 year of supportive-expressive group therapy (SET). Participants were 41 women randomized to SET. We coded emotional expression and story types (story vs. non-story) at the initial session, 4, 8, and 12 months. Women engaged in more storytelling in their initial than later sessions. In later sessions, women expressed significantly more emotion, specifically compassion and high-arousal positive affect. Direct communication (non-story) allowed more positive but also more defensive expression as women supported and challenged each other. Greater hostility in non-story and greater constrained anger during story were associated with increasing depression. Greater high-arousal positive affect in non-story and greater primary negative affect in story were associated with increasing social network size. These results inform clinicians about cues they might use to improve the effectiveness of cancer support groups.

Cancer patients' experiences of the early phase of individual counseling in an outpatient psycho-oncology setting.

Distress is a common and substantive problem associated with the invasive nature of cancer. Psychosocial interventions can alleviate distress and enhance quality of life, with a wealth of research demonstrating benefits of group interventions. Less is known, however, about the value of individual psychological counseling for cancer patients. The goal of our study was to understand patients' experiences of attending an individual psycho-oncology counseling service in a comprehensive cancer center in Canada. We conducted six focus groups to ask patients about their perceived benefits of the early phase of counseling. The 23 participants were predominantly women living in urban areas who sought counseling for emotional and coping difficulties. Using inductive analysis, we identified four interrelated themes: distress and need for support, challenges to service access, service benefits, and the therapeutic encounter. The therapeutic encounter formed a core component of patients' experiences, highlighting the benefits of specific therapeutic interventions and processes.

Art groups for marginalized women with breast cancer.

Professionally led support groups can significantly reduce distress, trauma symptoms, and pain for women with breast cancer. Despite the known benefits, women with breast cancer from marginalized groups tend not to participate in support groups. It is important to address barriers that prevent their participation and to identify types of support groups that appeal to as wide a range of women as possible. For this study, we interviewed women with breast cancer from marginalized groups in the San Francisco Bay Area (United States). We asked them about social, cultural, and psychological barriers that prevent participation in support groups, and about the potential of art groups to overcome these barriers. Our qualitative analysis of the interviews yielded findings that suggest a model for a type of support group that could make the benefits of support groups available to more women with breast cancer.

A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer.

OBJECTIVE: Sleep disturbances are common among women with breast cancer and can have serious consequences. The present study examined depression, pain, life stress, and participation in group therapy in relation to sleep disturbances in a sample of women with metastatic breast cancer. METHODS: Ninety-three women with metastatic breast cancer participated in a large intervention trial examining the effect of the group therapy on their symptoms. They completed measures of depression, pain, life stress, and sleep disturbance at baseline, 4, 8 and 12 months. RESULTS: The results showed that higher initial levels of depression at baseline predicted problems associated with getting up in the morning, waking up during the night, and daytime sleepiness. Increases in depression over the course of 12 months were associated with fewer hours of sleep, more problems with waking up during the night and more daytime sleepiness. Higher levels of pain at baseline predicted more problems getting to sleep. Increases in pain predicted more difficulty getting to sleep and more problems waking up during the night. Greater life stress at baseline predicted more problems getting to sleep and more daytime sleepiness. CONCLUSIONS: Depression, pain, and life stress scores were each associated with different types of negative change in self-reported sleep disturbances. Depression, especially worsening depression, was associated with the greatest number of types of negative change. The relationships found between sleep disturbance and depression, pain, and life stress suggest specific ways to address the problem of sleep disturbance for women with metastatic breast cancer and show how different types of disturbed sleep may be clinical markers for depression, pain, or life stress in this population.

A narrative view of art therapy and art making by women with breast cancer.

Art therapy (with an art therapist) and art making (without an art therapist) show promise as avenues for psychosocial support for women with breast cancer. The purpose of this study was to gain an in-depth understanding of how 17 women with breast cancer in Canada and the USA used art therapy and their own art making to address their psychosocial needs, focusing particularly on meaning making. Narrative analysis of interviews yielded four storylines: Art and Art Therapy as a Haven; Getting a Clearer View; Clearing the Way Emotionally; and Enhancing and Enlivening the Self. The storylines show existence being affirmed, confirmed and proclaimed through visual artistic expression and meaning making being achieved through physical acts of making.

Exploring the role of complementary and alternative medicine in public health practice and training.

OBJECTIVES: Consumer use of complementary and alternative medicine (CAM) in the United States continues to expand. Although conventional medicine has responded actively, the response from public health has been far less pronounced. To examine the potential for integrating CAM into public health contexts, an exploratory survey was conducted. DESIGN: A 19-item, self-administered survey instrument was used to collect participant data. SETTINGS/LOCATION: Participants were surveyed at the 2003 American Public Health Association (APHA) annual meeting while attending CAM-related talks sponsored by the Alternative and Complementary Health Practices Special Interest Group (ACHP SPIG). SUBJECTS: A convenience sample of 153 individuals was surveyed, which was predominantly female (81%) and Caucasian (68%), with an average age of 42 years. OUTCOME MEASURES: The survey instrument included items about participant and client demographics, participant use of CAM (personal and professional), perceived client interest in CAM, and several attitude measures. RESULTS: The majority of participants (64%) were currently employed as public health professionals working in a wide variety of settings with highly diverse populations. Personal use of CAM was high (66% using four or more modalities). The majority also reported integrating CAM into work settings. There was a significant relationship between personal and professional use of CAM. Participants overwhelmingly agreed that more professional training in this area was needed. CONCLUSIONS: This exploratory study provides insight into the potential role of CAM as an important resource in public health settings. Additional funding and research in this area is urgently needed.

Considering 'meaning' in the context of breast cancer.

In this article, we show that a psychological view of global and situational meanings is inadequate for understanding meaning making in the context of breast cancer. We outline research that has illuminated breast cancer meanings that differ from standard illness meanings and we highlight impediments to meaning making for women with breast cancer. We conclude that it is less helpful to promote a particular kind of illness meaning for women with breast cancer than to: (a) create conditions that women with breast cancer have said are conducive to meaning making; (b) accept and acknowledge meanings that women with breast cancer themselves find valuable; and (c) actively work to change dominant discourses that constrain meaning making for women with breast cancer.

Talking with text: communication in therapist-led, live chat cancer support groups.

CancerChatCanada is a pan-Canadian initiative with a mandate to make professionally led cancer support groups available to more people in Canada. Although online support groups are becoming increasingly popular, little is known about therapist-led, synchronous groups using live chat. The purpose of this study was to generate a rich descriptive account of communication experiences in CancerChatCanada groups and to gain an understanding of processes associated with previously-reported benefits. We used interpretive description to analyze interview segments from 102 patients, survivors and family caregivers who participated in CancerChatCanada groups between 2007 and 2011. The analysis yielded four inter-related process themes (Reaching Out From Home, Feeling Safe, Emotional Release, and Talking With Text) and one outcome theme (Resonance and Kinship). The findings extend previous research about text-only online support groups and provide novel insights into features of facilitated, live chat communication that are valued by group members.

Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis.

PURPOSE: Numerous studies have examined the comorbidity of depression with cancer, and some have indicated that depression may be associated with cancer progression or survival. However, few studies have assessed whether changes in depression symptoms are associated with survival. METHODS: In a secondary analysis of a randomized trial of supportive-expressive group therapy, 125 women with metastatic breast cancer (MBC) completed a depression symptom measure (Center for Epidemiologic Studies-Depression Scale [CES-D]) at baseline and were randomly assigned to a treatment group or to a control group that received educational materials. At baseline and three follow-up points, 101 of 125 women completed a depression symptom measure. We used these data in a Cox proportional hazards analysis to examine whether decreasing depression symptoms over the first year of the study (the length of the intervention) would be associated with longer survival. RESULTS: Median survival time was 53.6 months for women with decreasing CES-D scores over 1 year and 25.1 months for women with increasing CES-D scores. There was a significant effect of change in CES-D over the first year on survival out to 14 years (P = .007) but no significant interaction between treatment condition and CES-D change on survival. Neither demographic nor medical variables explained this association. CONCLUSION: Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with MBC in this sample. Further research is necessary to confirm this hypothesis in other samples, and causation cannot be assumed based on this analysis.

Videoconferencing for delivery of breast cancer support groups to women living in rural communities: a pilot study.

Women with breast cancer in rural areas are likely to exhaust their usual sources of psychosocial support while still facing challenges posed by breast cancer, but are unlikely to have access to professionally led support groups. In this community-based project, we assessed the feasibility and acceptability of providing support groups to women with breast cancer in a large rural area using videoconferencing and a workbook journal, and we assessed the intervention's potential to reduce distress and increase emotional expression and self-efficacy for coping with cancer. Twenty-seven women in the Intermountain Region of northeastern California participated in eight-session support groups led by an oncology social worker by going to nearby videoconferencing sites. Feasibility and acceptability were demonstrated. Older as well as younger women were comfortable using videoconferencing and said the groups were valuable because they promoted information sharing and emotional bonds with other women with breast cancer. They emphasized the importance of a professional facilitator and identified advantages of using videoconferencing for support groups. Pretest and posttest comparisons showed significant decreases in depression and posttraumatic stress disorder symptoms. The results suggest that the intervention has the potential to provide a valuable service that is not readily available in rural communities.

Distance art groups for women with breast cancer: guidelines and recommendations.

To overcome barriers that prevent women with breast cancer from attending support groups, innovative formats and modes of delivery both need to be considered. The present study was part of an interdisciplinary program of research in which researchers from counseling psychology, psycho-oncology, nursing, computer science, and fine arts have explored art making as an innovative format and telehealth as a mode of delivery. For this study, we conducted focus groups and interviews with 25 people with expertise about breast cancer, art, art therapy, and distance delivery of mental health services to generate guidelines for distance art-based psychosocial support services to women with breast cancer. A qualitative analysis of the focus group and interview data yielded guidelines for developers and facilitators of distance art groups for women with breast cancer pertaining to (a) emotional expression, (b) emotional support, (c) emotional safety, and (d) accommodating individual differences, plus special considerations for art therapy groups. Further research is needed pertaining to the use of computers, involvement of art therapists, and screening out vulnerable clients.

Using focus group results to inform preschool childhood obesity prevention programming.

OBJECTIVE: This study about maternal feeding practices and beliefs was conducted as background for the development of a childhood obesity prevention program for multi-ethnic parents in the USA receiving services from a federal government supplemental nutrition program for low-income mothers. DESIGN: Using a grounded theory approach, focus groups were conducted with low-income African American, white non-Hispanic (i.e. the majority Caucasian American population), Hispanic and Vietnamese parents to collect cross-cultural perspectives on: (a) infant and child feeding practices, (b) childhood overweight, (c) healthy dietary intake, (d) physical activity and inactivity, and (e) infant feeding information sources. RESULTS: A content analysis of the data yielded three main themes common to all four groups: (a) lack of awareness of the relationship between increased physical activity and health, (b) the use of food to influence behavior, and (c) the loss of parental control over feeding when a child starts child care or school, and revealed perspectives on age-appropriate food, infant satiety, overweight and information sources that were specific to each group. CONCLUSION: Interventions that enhance parent self-efficacy that build on themes that are specific to ethnic groups toward preventing childhood obesity are needed. There is also a need for culturally appropriate information for governmental nutrition programs that is in the client's own language and takes into account ethnic differences in beliefs and traditions.

Breast cancer and problems with medical interactions: relationships with traumatic stress, emotional self-efficacy, and social support.

This investigation examined relationships between breast cancer patients' psychosocial characteristics (impact of the illness, traumatic stress symptoms, emotional self-efficacy, and social support) and problems they perceived in their medical interactions and their satisfaction with their physicians. Participants were 352 women enrolled in a multicenter trial of the effects of group therapy for women with recently diagnosed primary breast cancer. The findings reported here are from a cross-sectional analysis of baseline data gathered prior to randomization. Problems interacting with physicians and nurses were associated with greater levels of cancer-related traumatic stress (p < 0.01), less emotional self-efficacy for cancer (p < 0.05), less satisfaction with informational support from family, friends, and spouse, and a tendency to perceive those sources of support as more aversive (p < 0.05). Women who were less satisfied with emotional support from their family, friends and spouse were less likely to feel satisfied with their physicians (p < 0.05). These patient characteristics identify women with primary breast cancer who are likely to experience difficulty in their interactions with nurses and physicians and to be less satisfied with their physicians.