BPD Compass: Using a dimensional model of psychopathology to treat co-occurring borderline personality disorder and posttraumatic stress symptoms.

BPD Compass is a transdiagnostic psychotherapy that includes cognitive, behavioral, and mindfulness skills targeting the personality dimensions of negative affectivity, disinhibition, and antagonism. Given considerable symptom comorbidity and overlap in etiology between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD), this study investigated whether BPD Compass holds promise as an integrated approach to simultaneously treating co-occurring BPD features and PTSD symptoms. Participants included 84 trauma-exposed adults who participated in a two-phase clinical trial (Phase 1: randomized controlled trial of BPD Compass vs. waitlist [n = 43]; Phase 2: open trial of BPD Compass [n = 41]). Compared to waitlist, BPD Compass led to medium-to-large-sized, significant improvements in BPD features, ßs = -.57 -.44, and facets of neuroticism, ßs < -.55--.73, as well as small, nonsignificant improvements in self-reported, ß = -.20, and clinician-rated PTSD symptom severity, ß = -.19. During treatment, within-person improvements in PTSD symptoms predicted subsequent improvements in BPD features, ß = .13, but not vice versa, ß = .07. Within-person PTSD symptom reduction also predicted subsequent improvement in all personality dimensions, whereas only within-person improvement in despondence, ß = .12, affective dysregulation, ß = .11, and dissociative tendencies, ß = .12, predicted PTSD symptom reductions. Findings offer preliminary support for the potential of BPD Compass to target BPD features and aspects of neuroticism and agreeableness among trauma-exposed adults. Moreover, PTSD symptom change predicting subsequent improvement in BPD features runs counter to current stage-based treatment models that emphasize BPD feature stabilization before engaging in trauma-focused therapy.

Trauma-related shame predicts daily non-medical prescription opioid use among individuals with PTSD symptoms.

Non-medical prescription opioid use (NMPOU) is the use of opioids without a prescription or in a way different from how they were prescribed and is the fourth most common type of drug use in the United States. Separate research has shown that trauma-related shame is linked to posttraumatic stress disorder (PTSD) and, respectively, opioid use. However, no study to date has empirically examined the association between trauma-related shame and NMPOU among individuals with PTSD symptoms. Forty adults with clinical or subclinical PTSD who reported engaging in NMPOU at least one day in the prior month before the study completed 28 days of daily surveys. Trauma-related shame was measured at baseline. NMPOU and underlying motives to engage in NMPOU were assessed once daily via a smartphone app. Twenty-four participants (60 %) reported NMPOU over the 28-day period. After controlling for PTSD symptoms and covariates, mixed models showed that higher trauma-related shame significantly predicted higher risk of daily NMPOU (B = 0.06, SE = 0.03, t = 2.14, p=.03). After controlling for false discovery rates, trauma-related shame also significantly predicted NMPOU due to the following motives (p's < 0.031): to manage depression/sadness, to manage anxiety, to manage other stress/worry, and to get high. Among individuals with PTSD, higher baseline trauma-related shame prospectively and positively predicted greater NMPOU over a four-week daily monitoring period. Findings suggest a need to attend to trauma-related shame and its impact on subsequent motivations to engage in NMPOU. Future research should examine how treatments may effectively target trauma-related shame to reduce NMPOU and more severe PTSD symptoms.

Disclosure of traumatic details and obsessive-compulsive contamination symptoms in sexual assault survivors.

OBJECTIVE: Contamination concerns are common following sexual victimization and are associated with increased attentional bias and difficulty disengaging from contamination cues. While most survivors of sexual trauma disclose their experience to others, it is unclear whether disclosure increases feelings of contamination or whether, consistent with the fever model of disclosure, existing contamination-related distress increases the amount of content shared during disclosure, indicative of attentional bias toward contamination-inducing aspects of the trauma memory. METHOD: Accordingly, the current study examined the directionality and relationships between contamination symptoms and content shared during sexual assault disclosure in 106 sexual assault survivors (76.4% women). Forced decision regression with subsequent independence test (RESIT) was used to identify directionality of relationships, and multivariate and linear regressions examined these proposed effects in the presence of assault and demographic characteristics. RESULTS: More severe contamination symptoms predicted greater sharing of details during sexual assault disclosure yet had no impact on sharing of emotions, cognitions, and beliefs during disclosures. Although RESIT suggested that contrary to other content domains, disclosure of social experiences may directionally predict contamination symptoms, this relationship did not retain statistical significance in a linear regression model. CONCLUSIONS: Findings support the fever model of disclosure and attentional bias theories regarding contamination-related stimuli, and suggest that survivors experiencing postassault contamination symptoms may be more likely fixate on the contamination-invoking details of the trauma memory when disclosing. Such fixation has the potential to interfere with typical treatment-related processes (e.g., habituation) and should be thoughtfully addressed to maximize treatment gains. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessment of Comorbid Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are commonly comorbid and share prominent features (e.g., intrusions, safety behaviors, and avoidance). Excellent self-report and clinician-administered assessments exist for OCD and PTSD individually, but few assess both disorders, and even fewer provide instruction on differential diagnosis or detection of comorbid OCD and PTSD. To address this gap in the literature, the current paper aims to (1) highlight diagnostic and functional similarities and differences between OCD and PTSD to inform differential diagnosis, (2) outline assessment recommendations for individuals with suspected comorbid OCD and PTSD, OCD with a significant trauma history or posttraumatic symptoms, or PTSD with significant obsessive-compulsive symptoms, and (3) explore future directions to evaluate and improve methods for assessing co-occurring OCD and PTSD.

Improvement in Post-traumatic Stress Symptoms Following an Internet-based Cognitive-Behavioral Intervention for Insomnia: An Open Trial among Rural Appalachian Women.

Appalachian women face significant health disparities and have limited access to health care. Mental health conditions and treatment-seeking are stigmatized in Appalachian communities. Appalachian women may benefit from web-based interventions targeting less stigmatized health complaints (e.g., insomnia), while simultaneously yielding benefit in associated mental health conditions including symptoms of post-traumatic stress disorder (PTSD). In this study, 37 trauma-exposed adult women aged 45 and older from rural Appalachian Kentucky completed a six-session online self-administered cognitive behavioral therapy for insomnia (CBT-I) intervention and completed measures of PTSD symptoms, insomnia, and depression at pre- and post-treatment. Participants reported a significant reduction in PTSD symptoms from pre- to post-intervention, and this remained significant after adjusting for severity of insomnia and depression pre-treatment. Pending replication in a randomized controlled trial, web-based CBT-I may offer an adjunctive mental health treatment option that circumvents cultural stigmas and reduces PTSD symptoms for trauma-exposed Appalachian women.

Obsessive-Compulsive Symptoms and Daily Experiences of Posttraumatic Stress and Mental Contamination Following Sexual Trauma.

Although cross-sectional research highlights similarities between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) among individuals exposed to sexual trauma, little is known about how these disorders relate over time. The goal of the present study was to examine whether 1) OCD symptoms prospectively predicted daily symptoms of PTSD, and 2) OCD and PTSD symptoms prospectively predicted daily experiences of sexual trauma-related mental contamination (i.e., dirtiness in the absence of a physical pollutant). Forty-one women with a sexual trauma history completed baseline measures of OCD and PTSD, as well as twice-daily assessments of PTSD symptoms and mental contamination over a two-week period. Total OCD symptoms and the unacceptable thoughts dimension significantly predicted daily PTSD symptoms after accounting for other OCD dimensions. Only total OCD symptoms significantly predicted daily mental contamination when examined together with total PTSD symptoms. No individual PTSD or OCD clusters/dimensions significantly predicted daily mental contamination when examined simultaneously. Findings from this study highlight the nuanced associations among OCD symptoms, PTSD symptoms, and experiences of mental contamination. Future research is needed to further understand the development of PTSD, OCD, and mental contamination over time to inform targets for intervention.

Fear of sin and fear of God: Scrupulosity predicts women's daily experiences of mental contamination following sexual trauma.

Mental contamination refers to feelings of dirtiness in response to thoughts, images, or memories. Mental contamination is frequently reported after sexual trauma and is associated with symptoms of posttraumatic stress disorder (PTSD). Differences in individuals' views about morality and purity may influence the severity of mental contamination, though this has been studied primarily outside of samples assessed for trauma and/or PTSD. The present study addressed this gap by investigating scrupulosity as a prospective predictor of daily sexual trauma-related mental contamination and PTSD symptoms. Participants included 40 adult women with a history of sexual trauma and current sexual trauma-related mental contamination who completed baseline diagnostic interviews and questionnaires followed by two assessments every day for 2 weeks. The results indicate that scrupulosity was positively correlated with PTSD symptom severity and sexual trauma-related mental contamination at baseline. Scrupulosity was also a prospective predictor of increased daily sexual trauma-related mental contamination, B = 0.19, SE = 0.07, p = .010, but not daily PTSD symptoms, B = -0.10, SE = .08, p = .198. The findings indicate that scrupulosity may be an important factor in understanding recovery from sexual assault.

Trauma-Related Shame and Guilt as Prospective Predictors of Daily Mental Contamination and PTSD Symptoms in Survivors of Sexual Trauma.

Mental contamination (MC), the experience of dirtiness in the absence of a physical contaminant, has established links with posttraumatic stress disorder (PTSD). Shame and guilt have well-documented relationships with symptoms of PTSD and may play a role in the development and maintenance of MC. The present study examined whether trauma-related shame and guilt prospectively predicted daily MC and symptoms of PTSD among 41 women with a history of sexual trauma. Women completed baseline and twice-daily assessments of MC and symptoms of PTSD over a 2-week period and baseline measures of trauma-related shame and guilt. Two sets of hierarchical mixed linear regression models examined individual and combined fixed effects of baseline trauma-related guilt (guilt cognitions and global guilt) and shame in predicting daily trauma-related MC and symptoms of PTSD. Trauma-related shame positively predicted both daily MC and PTSD. This association remained robust even when accounting for the experience of trauma-related guilt. Neither trauma-related guilt cognitions nor global guilt predicted daily MC or PTSD. While other studies have addressed shame related to sexual assault, this is the first study to demonstrate a positive prospective relationship between shame and trauma-related MC. Findings regarding PTSD and shame are consistent with a growing literature. Further research is needed to better understand the temporal relationships between trauma-related shame, MC, and symptoms of PTSD, including how these variables interact and change over the course of PTSD treatment. A better understanding of the factors influencing the development and maintenance of MC can inform efforts to more easily target and improve MC, and subsequently PTSD.

Advancing the Measurement of Trauma-Related Shame Among Women With Histories of Interpersonal Trauma.

Shame is a predominant emotion for many interpersonal trauma (IPT) survivors and is associated with more severe posttraumatic stress disorder (PTSD) symptoms. Measurement challenges have led to difficulties in understanding the impact of trauma-related shame. The Trauma-Related Shame Inventory (TRSI) was developed to address this limitation, yet additional psychometric support is needed. The present study evaluated and provided psychometric support for the TRSI among women with IPT histories, although recommendations for improvement are discussed. The impact of trauma-related shame, relative to trait shame and trauma-related guilt, on PTSD symptoms was also studied, with results suggesting that trauma-related shame had the strongest association.

Concurrent and proximal associations among PTSD symptoms, prescription opioid use, and co-use of other substances: Results from a daily monitoring study.

OBJECTIVE: Posttraumatic stress disorder (PTSD) and nonmedical prescription opioid use (NMPOU) are linked. Much of the research documenting this association uses cross-sectional or longitudinal designs that describe patterns of use over extended intervals. The present study used a daily monitoring design to examine how daily fluctuations in PTSD symptoms predicted patterns of prescription opioid use (both medical and nonmedical) and co-use of other substances. This approach has distinct advantages for understanding proximal temporal relations between PTSD symptom variation and substance use patterns. METHOD: Forty adults with clinical or subclinical PTSD and past-month NMPOU completed daily measures of PTSD symptoms, physical pain, prescription opioid use, and other substance use for 28 days using a smartphone application. RESULTS: Same day co-use of prescription opioids and at least one other substance was common. Higher-than-typical PTSD symptoms on a given day (within-person) was associated with an increased likelihood of reporting NMPOU (overall and with co-use of one or more additional substances) on the same day. This association was specific to PTSD alterations in arousal and reactivity symptoms (Criteria E). Neither total PTSD symptoms nor individual PTSD symptom clusters prospectively predicted next-day prescription opioid use (overall or with co-use). Use of prescription opioids also did not predict next-day PTSD symptom severity. CONCLUSION: This is the first study to demonstrate positive associations between day-to-day fluctuations in PTSD symptoms and NMPOU. Results from the current study also highlight the importance of examining polysubstance use patterns among individuals with PTSD who use prescription opioids. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The role of posttraumatic guilt and anger in integrated treatment for PTSD and co-occurring substance use disorders among primarily male veterans.

OBJECTIVE: PTSD and substance use disorders (SUD) frequently co-occur among veterans. Integrated exposure-based treatments, such as Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE), are efficacious in reducing PTSD and SUD symptoms and posttraumatic emotions. This study examines whether guilt and anger (a) decreased in a randomized clinical trial comparing COPE with Relapse Prevention (RP) therapy for SUD and (b) mediated PTSD and SUD symptom reductions or vice versa. METHOD: Veterans (90.1% men) diagnosed with PTSD and SUD were randomized to 12 sessions of COPE (n = 54) or RP (n = 27). Guilt and anger were assessed at 10 time points during treatment. Multilevel linear models assessed changes in guilt and anger across treatments and lagged multilevel mediation analyses assessed within-subject change in guilt and anger predicting PTSD and percent days of substance use, and vice versa. RESULTS: Guilt (B = -.12, SE = .02, p < .001) and anger (B = -.13, SE = .02, p < .001) improved in both treatments, however guilt was significantly lower in Sessions 7 through 11 among veterans receiving COPE. Improvement in guilt mediated PTSD symptom improvement in both treatment groups (B = -.08, SE = .04, 95% CI [-.16, -.01]), and PTSD symptom improvement mediated anger reduction in COPE (B = -.03, SE = .01, 95% CI [-.06, -.01]). The substance use models were insignificant. CONCLUSIONS: Among veterans, integrated, trauma-focused treatments may be associated with greater guilt (directly) and anger (indirectly) reductions due to processing trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Daily Associations Between Trauma-Related Mental Contamination and Use of Specific Coping Strategies: Results of a Daily Monitoring Study.

Mental contamination (MC)-a sense of dirtiness experienced without contacting an identifiable pollutant-is a distressing and enduring experience among many survivors of sexual trauma. MC has been linked to more frequent use of avoidant coping behaviors (e.g., washing behavior, substance use, binge eating) and approach coping. However, it is unclear if specific approach and avoidant coping strategies are more consistently related to perseverative experiences of trauma-related MC, if the use of certain strategies predicts changes in MC, and if fluctuations in MC predict the use of certain strategies. The present study evaluated contemporaneous and prospective relationships between sexual trauma-related MC and use of 11 specific coping strategies among 41 women with a history of sexual trauma using an experience sampling design. Women completed twice-daily assessments of coping strategy use and MC for 14 days. Between-persons, women reporting more intense MC on average reported more frequent use of distraction, denial, giving up, self-blame, thought suppression, washing behavior, emotional processing, and emotional expression than those experiencing less intense MC. Within-person increases in MC were associated with more frequent concurrent use of all coping strategies except seeking support. Lastly, within-person increases in MC predicted more frequent use of giving up, substance use, and seeking support at the next assessment and within-person increases in substance use predicted less severe MC at the next assessment. Future work should aim to identify factors influencing the selection and/or quality of use of these specific coping strategies among individuals experiencing MC.

Mental contamination, PTSD symptoms, and coping following sexual trauma: Results from a daily monitoring study.

Mental contamination (MC) - dirtiness experienced in the absence of contact with a physical contaminant - has been linked to PTSD symptoms following sexual trauma. However, there is limited understanding regarding the temporal nature of this association. The present study utilized experience sampling to examine associations between baseline and daily experiences of MC and PTSD symptoms and the mediating role of avoidance and approach coping among a sample of 41 adult women with a history of sexual trauma and current MC. Participants completed baseline measures and 14 days of twice-daily assessments. Results indicated that daily MC and PTSD symptoms were bidirectionally related. The tendency to engage in avoidance coping positively mediated relations between 1) baseline MC and daily PTSD symptoms and 2) baseline PTSD symptoms and daily MC. Further, daily avoidance coping (T-1) positively mediated associations between daily MC (T-2) and subsequent daily PTSD symptoms (T). Approach coping was not a mediator (between- or within-) in any models. Findings lend support to a mutual maintenance model of PTSD symptoms and trauma-related MC mediated by avoidance coping. Future research over a more extended period is warranted to clarify whether PTSD symptoms and MC indeed mutually maintain or exacerbate one another over time.

Posttraumatic stress and risky sex in trauma-exposed college students: the role of personality dispositions toward impulsive behavior.

Objectives: Posttraumatic stress disorder (PTSD) has been linked to risky sexual behavior (RSB). However, little is known regarding the role of impulsivity in this relation among college students. Participants: The present study examined the moderating role of impulsivity dispositions on the relation between PTSD symptoms and past-year RSB in a sample of 221 trauma-exposed undergraduate students (77.4% female). Results: Two separate negative binomial regression models examined each impulsivity disposition's unique moderating effect on the association between PTSD symptoms and high risk/casual sex. In the high risk model, significant interactions were found for the urgency dispositions, (lack of) premeditation and (lack of) perseverance, though the pattern of these relations differed across these dispositions. Only positive main effects for negative urgency and (lack of) premeditation emerged in the casual sex model. Conclusions: The present study expands on the limited literature on the role of impulsivity in the relation between PTSD and RSB in trauma-exposed college students.

Temporal dynamics of symptom change among veterans receiving an integrated treatment for posttraumatic stress disorder and substance use disorders.

The present study examined temporal patterns of symptom change during treatment for comorbid posttraumatic stress disorders (PTSD) and substance use disorders (SUDs). We hypothesized that PTSD symptom severity would predict subsequent-session substance use and that this association would be particularly strong among patients who received an integrated treatment versus SUD-only treatment. Participants were 81 United States military veterans with current PTSD and an SUD who were enrolled in a 12-week, randomized controlled trial examining the efficacy of an integrated treatment called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) compared with cognitive behavioral relapse prevention therapy (RP). Lagged multilevel models indicated that PTSD symptom improvement did not significantly predict the likelihood of next-session substance use (likelihood of use: B = 0.03, SE = 0.02, p = .141; percentage of days using B = -0.02, SE = 0.01, p = .172. Neither substance use, B = 1.53, SE = 1.79, p = .391, nor frequency of use, B = 0.26, SE = 0.50, p = .612, predicted next-session PTSD symptom severity in either treatment condition. Stronger associations between PTSD symptoms and next-session substance use were expected given the self-medication hypothesis. Additional research is needed to better understand the temporal dynamics of symptom change as well as the specific mediators and mechanisms underlying symptom change.

Avoidance Coping Partially Accounts for the Relationship Between Trauma-Related Shame and PTSD Symptoms Following Interpersonal Trauma.

Research has demonstrated that individuals experiencing trauma-related shame exhibit greater posttraumatic stress disorder (PTSD) symptoms. However, little research has investigated additional factors relevant to the shame-PTSD relationship. The current study examined the role of avoidance and approach coping in accounting for the trauma-related shame-PTSD association among 60 women who had experienced interpersonal trauma. Indirect effects tests revealed that avoidance coping partially accounted for the association between shame and interviewer-assessed PTSD symptoms, ß = .21, SE = 0.08, 95% confidence interval (CI) = [0.03, 0.36]. These findings offer a novel contribution to the growing literature examining negative outcomes following interpersonal trauma.

Mental contamination, disgust, and other negative emotions among survivors of sexual trauma: Results from a daily monitoring study.

Mental contamination (MC)-feelings of dirtiness triggered by internal sources-is a potentially important yet understudied factor for survivors of sexual trauma. MC has been linked to disgust and other negative emotions (e.g., shame, guilt) cross-sectionally and in lab-based paradigms but not yet examined in ecological contexts. Additionally, links between MC and distinct negative emotions have not been studied systematically. The present study thus modeled relationships between MC and specific emotions both across and within days over a daily monitoring period. Forty-one females with sexual trauma history and associated MC completed twice-daily assessments of MC and seven emotions (disgust, shame, guilt, anger, hopelessness, sadness, anxiety) over 2 weeks via a smartphone app. Baseline MC and average daily MC were largely associated with higher daily averages of negative emotions. Concurrently, within-person changes in MC and negative emotions were also positively linked. Unexpectedly, intraindividual changes in MC were largely not associated with later negative emotions, whereas several emotions were negatively associated with later MC. Notably, MC among screened sexual trauma survivors was much more prevalent compared to prior research. Clinical relevance and future recommendations for ecological research in trauma-related mental contamination are discussed.

A secondary analysis of a brief video intervention on suicidal ideation among recent rape victims.

Although rape has been linked to risk for suicidal ideation and attempts, there are scant data on the efficacy of brief interventions to reduce suicidality among recent rape victims. This secondary analysis of a randomized controlled trial investigated whether a video intervention delivered in the emergency department (ED), cortisol measured at the ED, and prior rape history predicted postrape suicidal ideation independently or in combination with the other predictors. Participants were 235 women aged 15-71 years who presented to the ED for a sexual assault medical forensic examination and were randomly assigned to either receive a video intervention that addressed avoidance and promoted healthy coping strategies or standard care prior to the examination. Participants also provided a blood sample for cortisol and completed at least one of three follow-ups at 6 weeks, 3 months, or 6 months postrape. The intervention conferred protection against suicidal ideation among women with elevated cortisol and a prior rape; however, it did not reduce risk for women without a prior rape, particularly those with elevated cortisol. It may be important to consider the influence of prior rape and neuroendocrine reactivity in developing treatments to address suicidal ideation among rape victims. More specifically, there appears to be value in screening victims for prior rape and administering this brief intervention to reduce suicidal ideation; however, other avenues should be explored for victims without a prior rape history. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evaluating the mediating effects of perceived vulnerability to disease in the relation between disgust and contamination-based OCD.

Contamination-based obsessive-compulsive disorder (OCD) is thought to develop and be maintained by excessive propensity to experience disgust, particularly in response to perceived contaminants, and dysfunctional threat appraisals pertaining to illness. The present studies attempted to integrate these lines of research by testing the degree to which contamination-based OCD is associated with individual differences in disgust propensity and sensitivity, affective distress in response to perceived contaminants, and perceived threat of illness. In Study 1, a convenience sample of 185 adults completed self-report scales assessing obsessive-compulsive symptoms, disgust propensity and sensitivity, germ aversion, and perceived infectability. Multivariate regression showed that disgust propensity and germ aversion were the only significant predictors of contamination-based obsessions and compulsions. Exploratory analyses suggested that there was a significant indirect effect of disgust propensity on contamination-based obsessions and compulsions via germ aversion. Findings from Study 1 were replicated using a sample of twenty-six obsessive-compulsive participants. Despite the substantially smaller sample, the proportion of the total effects attributable to the mediating effect of germ aversion was comparable, consistent with a significant partial mediation in both samples. These results together suggest that contamination-based OCD symptoms are likely maintained and motivated by basic affective processes.

The association between psychological functioning and social support and social constraint after cancer diagnosis: a 30-day daily diary study.

This study evaluated one positive and one negative aspect of social functioning (social support and social constraint, respectively) to increase understanding of its relation to psychological functioning (distress and wellbeing) after cancer diagnosis. Participants in this longitudinal study were recently diagnosed, predominately late stage, first primary cancer survivors (n = 48). Data collection involved a 30-day period of daily assessment. Data were analyzed using multilevel linear models. As in prior studies, none of the variables changed significantly over time (ps = .07 to .99). Based on the intraclass correlation coefficient, 51 to 75% of the variance in the daily assessment data are attributable to between-person differences. There was a positive relationship between social constraint and both general and cancer-specific distress (ps < .05) and between social support and cancer-specific wellbeing (ps < .001). In prospective models, higher than average general distress predicted higher social support the next day (p = .004) and higher than average cancer-specific wellbeing predicted more social constraint the next day (p = .01). The findings lend some support to the interdependence of social functioning and psychological functioning after cancer diagnosis.