Predictors of psychological distress during self-isolation.

OBJECTIVES: Global pandemics, such as the current COVID-19 pandemic, are predicted to increase in prevalence in the future. Transmission suppression techniques such as social distancing and stay-at-home restrictions have introduced an abundance of additional stressors while simultaneously reducing our capacity to cope with stress, thus increasing the collective burden of the pandemic. Numerous psychosocial factors have been identified to protect against distress in difficult circumstances. However, it is unknown whether these factors will continue to be protective in the pandemic context. DESIGN: The aim of the current study was to determine whether locus of control (LOC), coping style or self-compassion were debilitating or protective factors towards psychological well-being (depression, anxiety, stress and positive and negative affect) during the COVID-19 pandemic. METHODS: In the current study, Australian adults (N = 176) completed a longitudinal online survey (two time points, 2 weeks apart) incorporating measures of demographics, locus of control, coping, self-compassion (measured at T1), depression, anxiety, stress and positive and negative affect (measured at T1 and T2) throughout June-August 2020, during the height of lockdown in Australia. RESULTS: Multiple regression analyses suggested that avoidant coping was predictive of increases in stress and negative affect across time points. Additionally, self-compassion was predictive of increased positive affect across time points. CONCLUSIONS: These results suggest that the pandemic context represents a unique stressor, demanding a distinctive set of strategies and psychosocial characteristics to cope. Interventions targeted at reducing avoidant coping behaviours and promoting self-compassion may contribute to improvements in psychological well-being during the COVID-19 pandemic as well as future pandemics.

Which, who and when? Therapeutic processes in group cognitive behaviour therapy for anxiety disorders.

The evidence for the effect of therapeutic alliance in group cognitive behaviour therapy (CBT) for anxiety disorders is unclear. Identifying whether the alliance-outcome relationship depends on (1) which components are assessed, (2) who is measuring the alliance and (3) when the alliance is measured will help to clarify the role of the client-therapist relationship in therapy. The present study explored the effects of alliance component (agreement vs. bond), rater perspective (client vs. therapist) and timing (early vs. late therapy) on the alliance-outcome relationship. Individuals with an anxiety disorder enrolled into transdiagnostic group CBT were studied, with n = 78 at early therapy and n = 57 at late therapy. Results showed that greater client-rated agreement significantly predicted improved post-treatment outcomes throughout the course of therapy, while stronger client-rated bond in late therapy predicted reduced treatment gains. In contrast, therapist perceptions of agreement and bond were not associated with post-treatment outcomes at any point in therapy. Client-reported group cohesion also was not associated with additional variance in outcome after accounting for client-rated alliance. Overall, the findings highlight the importance of prioritizing the client's perception of the client-therapist relationship in CBT for anxiety disorders, as well as distinguishing the effects of component, rater and timing in future process-outcome studies.

Impact of group transdiagnostic cognitive-behavior therapy for anxiety disorders on comorbid diagnoses: Results from a pragmatic randomized clinical trial in primary care.

BACKGROUND: Anxiety and depressive disorders are the most common mental illnesses worldwide, with most individuals meeting criteria for more than one diagnosis. Most cognitive-behavioral therapy (CBT) approaches target only one disorder at a time, resulting in the need to treat comorbid diagnoses sequentially. Transdiagnostic CBT protocols have been developed that simultaneously treat principal and comorbid disorders. METHOD: The current study reports on a secondary analysis of data from a pragmatic effectiveness randomized trial of group tCBT in comparison to treatment-as-usual (TAU) in primary care. Of the trial sample of 231 patients, 191 had at least one comorbid diagnosis of clinical severity at T0. RESULTS: Overall rates of comorbidity decreased over time (82.0% at T0, 45.0% at T1, 45.7% at T3) and those receiving tCBT showed a significantly lower rate of comorbidity at T1 (33.7%) than TAU (55.7%) and at T3 (tCBT: 27.9%, TAU: 60.2%). Comorbid diagnosis severity ratings reduced to a significantly greater extent in tCBT than in TAU. CONCLUSIONS: tCBT is effective in promoting remission of and reducing the severity of comorbid diagnoses. Implications for the treatment of whole persons as opposed to specific diagnoses is discussed.

A Scoping Review of Stress Beliefs: Literature Integration, Measurement Issues, and Theoretical Concerns.

BACKGROUND: Individual stress beliefs are associated with stress-related behavioral responses and health consequences. The Common-Sense Model of Self-Regulation may help in understanding the role of stress beliefs in these behavioral responses and consequences. PURPOSE: To synthesize empirical studies exploring the relationship between stress beliefs and stress-related behavioral responses and health consequences using the Common-Sense Model as a guiding framework. METHODS: Peer-reviewed journal articles on stress beliefs in PsycArticles, PsycINFO, PubMed, Scopus, and Sociological Abstracts were included if they were in English, reported on adult humans. Nineteen of the 1,972 unique articles reporting on 24 studies met inclusion criteria. Study quality was assessed with existing reporting criteria. RESULTS: Four of the five Common-Sense Model representations were included across the review studies, namely Identity, Cause, Consequences, and Control. Consequences and Control-related stress beliefs are associated with stress-based health and behavioral outcomes. One study explored Identity-related stress beliefs with health outcomes, reporting no relationship. No study assessed the relationship between Cause-related stress beliefs and behaviors or health outcomes. No study has explored any aspect of Timeline-related stress beliefs. Study quality ranged from very low to very high. CONCLUSIONS: There is limited evidence exploring stress-related beliefs and behaviors and health outcomes. According to the Common-Sense Model, the Timeline representations remains to be investigated in the stress context, and Identity and Cause are under-researched. This review highlights future directions for stress beliefs research.

Self-compassion and hope in the context of body image disturbance and distress in breast cancer survivors.

OBJECTIVE: Greater hope and self-compassion have individually been associated with lower psychological distress in women with breast cancer. Self-compassion is also associated with lower body image distress in this population, yet it is unknown whether hope also has this association. This study aimed to investigate the extent to which hope accounts for body image distress and psychological distress in breast cancer survivors alone, and in direct comparison to self-compassion. METHOD: A total of 195 women were recruited from the Breast Cancer Network Australia and completed a cross-sectional online anonymous questionnaire containing self-report measures of body image (Body Image Scale), self-compassion (Self Compassion Scale-SF), hope (State Hope Scale), psychological distress (depression, anxiety, stress; DASS), and demographic/medical questions. RESULTS: Self-compassion and hope were inversely correlated with all outcomes. Hierarchical linear regression analyses indicated that self-compassion and hope uniquely explained variance in all outcomes with different magnitudes of strength. Comparison of standardised betas indicated (a) Body image distress-self-compassion (Bstd = -.355) vs hope (Bstd = -.161); (b) Stress-self-compassion (Bstd = -.562) vs hope (Bstd = -.287); (c) Depression-hope (Bstd = -.447) vs self-compassion (Bstd = -.374); (d) Anxiety-hope (Bstd = -.406) vs self-compassion (Bstd = -.249). CONCLUSION: The unique contribution of self-compassion and hope in explaining body image distress and psychological distress suggests that combined, hope-focused components of therapy may be suitable additions to the growing array of self-compassion-based psychosocial interventions to address body image and psychological distress concerns of women with breast cancer.

Factors associated with professional healthcare advice seeking in women at risk for developing breast cancer-related lymphedema.

OBJECTIVES: Approximately 6-20% of breast cancer patients undergoing lymph node surgery will develop lymphedema. At-risk individuals are encouraged to seek professional healthcare advice if symptoms arise. This study aimed to identify cognitive and affective factors associated with professional healthcare advice (PHCA) seeking behavior in women with heightened lymphedema risk. METHODS: Women with increased lymphedema risk (N=462) completed an online survey measuring cognitive and affective responses to lymphedema risk, including the Illness Perception Questionnaire (Revised), and adherence to seeking PHCA. RESULTS: Overall, 62% of women reported seeking professional healthcare advice if symptoms arose. Logistic regression analysis indicated that adherence to seeking PHCA if lymphedema symptoms arise was associated with greater illness coherence, belief in the efficacy of seeking PHCA, and lymphedema risk-related emotional distress. CONCLUSION: Women were more likely to seek PHCA if symptoms arose if they held a coherent understanding of lymphedema and believed in the usefulness of seeking PHCA. For these women, psychological distress associated with lymphedema risk was associated with enhanced adherence to seeking PHCA. PRACTICE IMPLICATIONS: Health professionals should target lymphedema education to ensure at-risk women have a coherent understanding of lymphedema and that they believe in the effectiveness of seeking PHCA to help manage lymphedema symptoms.

Facilitating decision-making in women undergoing genetic testing for hereditary breast cancer: BRECONDA randomized controlled trial results.

BACKGROUND: Decision-making concerning risk-reducing mastectomy for women at hereditary risk of breast cancer entails complex personal choices. Deciding whether and how to restore breast shape after risk-reducing mastectomy is a key part of this process. We developed a web-based decision aid, BRECONDA (Breast Reconstruction Decision Aid), to assist women in decision-making regarding breast reconstruction. METHOD: This study assessed the efficacy of BRECONDA to assist women at increased risk of breast cancer in making decisions regarding risk-reducing mastectomy in terms of decisional conflict, knowledge, and satisfaction with information. Women at hereditary risk of breast cancer (N = 64) were recruited into this randomized controlled trial from four Australian hereditary cancer clinics. Participants initially provided online consent and completed baseline questionnaires assessing decisional conflict, knowledge, and satisfaction with information. They were then randomly assigned to either: 1) Intervention - unlimited access to BRECONDA, with usual care; or, 2) Control - usual care. At 2-months follow-up (N = 60) the outcomes were re-assessed. Intervention participants also completed user acceptability ratings for the intervention overall and specific key modules. RESULTS: MANCOVA analyses indicated that Intervention participants reported lower decisional conflict (P = 0.027), and greater knowledge (P = 0.019) and satisfaction with information (P < 0.0005) at 2-months follow-up compared with Controls. Intervention participants reported high user acceptability and satisfaction with the intervention. CONCLUSION: BRECONDA benefits women considering risk-reducing mastectomy by reducing decisional conflict, and improving knowledge and satisfaction with information. These benefits, coupled with high user acceptability, demonstrate the feasibility of implementing BRECONDA in the hereditary cancer risk context.

Delineating the relationship between stress mindset and primary appraisals: preliminary findings.

Stress mindset theory suggests that positive stress beliefs lead to positive, rather than negative, outcomes when engaging with stressors. Similarly, the Transactional Model of Stress predicts that perceiving a stressor as challenging leads to positive outcomes whereas negative perceptions of the stressor as threatening invoke negative outcomes. The aim of this study was to provide preliminary data examining the nature of the relationship between stress mindset and primary appraisals. It was predicted that positive beliefs about stress would be associated with perceiving a stressful situation as more challenging, and inversely related to perceptions of threat. Participants (N = 124) initially completed measures assessing stress mindset, lifetime and current perceived stress, trait anxiety, and self-efficacy. Then participants received a set of instructions regarding a stressful mathematics task, followed by completion of post-manipulation stress mindset and primary appraisals measures, prior to completing the mathematics task. Multiple linear regression analyses revealed that participants who held a greater number of positive beliefs (as opposed to negative beliefs) about stress also perceived the stressor as being more challenging. However, there was no significant relationship between valence of beliefs and threat appraisals. These findings provide initial evidence for the nature of the relationship between valence of stress beliefs and challenge appraisals. Further research is needed to understand how stress beliefs impact on the way in which an individual copes with stressful situations.

Axillary reverse mapping in patients with breast cancer: Is it oncologically safe?

BACKGROUND: Axillary reverse mapping (ARM) is a technique used to identify the lymphatics draining the arm. The aim of this study was to examine the prevalence and predictors of ARM node metastases in breast cancer patients undergoing an axillary lymph node dissection (ALND). METHODS: A total of 87 patients were enrolled in this study. Patent V Blue dye was injected in the upper arm for ARM node localization. All patients had an ALND with the identified ARM node removed and sent separately for histologic analysis. RESULTS: Of 67 (77%) patients in whom an ARM node was identified, 49 (73%) were negative and 18 (27%) were positive for metastases on final histopathology. Positive ARM node status was significantly associated with advanced axillary disease, and larger primary cancers. Patients requiring a completion ALND due to a positive sentinel lymph node biopsy (SLNB) with non-suspicious ARM nodes during surgery did not have ARM node metastases. CONCLUSIONS: There is a high risk of ARM node involvement, approximately a quarter, in patients with preoperatively known lymph node metastases from breast cancer. However, it may be safe to preserve a clinically non-suspicious ARM node in patients with a positive SLNB who require a completion ALND. J. Surg. Oncol. 2016;113:726-731. © 2016 Wiley Periodicals, Inc.