Expressive disclosure to improve well-being in patients with amyotrophic lateral sclerosis: a randomised, controlled trial.

Amyotrophic lateral sclerosis (ALS) is a terminal neurological disease associated with progressive paralysis, loss of communicative ability and functional decline. Expressive disclosure may help people with ALS, particularly those who are emotionally or socially inhibited, meet psychological challenges associated with the disease. People with ALS (N = 48) were randomised to expressive disclosure about their disease or no disclosure. Psychological well-being (affect, depression and quality of life) was assessed pre-intervention and also three and six months later. Results of multi-level models indicated that the group that disclosed thoughts and feelings about ALS had higher well-being than the control group at three months post-intervention, but not six months. Ambivalence over emotional expression (AEE) moderated three-month post-intervention well-being. Those low in AEE had higher well-being than those high in AEE regardless of condition. Those high in AEE, who disclosed, had increased well-being from pre-intervention, whereas controls had decreased well-being from pre-intervention. Expressive disclosure may be helpful for people with ALS, but only those who have difficulty expressing emotions. In addition, the intervention had only temporary effects; the dynamic challenges of ALS progression may mean that the effect of processing thoughts and feelings about the disease in one stage may not generalise to later stages.

The dynamics of quality of life in ALS patients and caregivers.

BACKGROUND: Quality of life (QOL) in people with amyotrophic lateral sclerosis (ALS) and their caregivers may depend on disease progression, premorbid characteristics (e.g., personality or demographics), or idiosyncratic effects (e.g., life events unrelated to the disease). Furthermore, effects may differ for patients and caregivers; physical decline may impact the caregiver more than the patient. PURPOSE: The present study examined QOL in ALS patients and their caregivers over the course of the illness. METHODS: Longitudinal data from ALS patients (N = 55) and caregivers (N = 53) yielded estimates of the sources of and changes over time in total QOL as well as individual domains (psychological existential, physical, and social) as measured by the McGill Quality of Life Questionnaire. RESULTS: For both patients and caregivers, about half of QOL variance emerged from stable individual differences. Passage of time did not affect QOL in patients, but total QOL and particularly QOL related to physical symptoms declined over time in caregivers. Gender was mostly unrelated to QOL in patients and caregivers, but younger caregivers had lower QOL across a number of domains. CONCLUSIONS: Low QOL among ALS patients is likely due to pre-existing individual differences, whereas both individual differences such as demographics (e.g., age) and disease progression are likely to affect QOL among caregivers.

Psychological health in patients with amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease with no known effective treatment or cure. Clinicians often expect that ALS patients will experience depression following the diagnosis because ALS is a terminal disease. The objective of the current study was to examine the evidence from the literature on psychological health in ALS patients in order to determine the prevalence and severity of depression in this population. Twenty-eight studies of ALS patients, conducted over the past 20 years, were reviewed and evaluated. The cumulative evidence suggests that clinically significant depression is neither as prevalent nor as severe as might be expected. Methodological limitations that are inherent to the measurement of depression in ALS, including the lack of appropriate instruments, small sample sizes, and reliance on cross-sectional data, have contributed to the wide range of reported results. We conclude that ALS patients are more likely to present with hopelessness and end-of-life concerns than clinically significant depression. It is important to assess a broad range of potential psychological distress early in the course of ALS, rather than focus specifically on depression, because the manner in which patients cope with their disease can affect their longevity.

Goal shifts following reminders of mortality: reconciling posttraumatic growth and terror management theory.

Research findings within posttraumatic growth (PTG) and terror management theory (TMT) currently appear contradictory. Following confrontations with mortality, PTG research demonstrates intrinsic goal shifts, whereas TMT suggests extrinsic shifts. The current studies examine factors contributing to these inconsistent results. Study 1 demonstrates that perceived death threat is associated with PTG effects. Study 2 illuminates the importance of duration of death processing. Study 3 demonstrates that existing goal values and duration and type of processing all interact in determining ultimate goal structure, with a match between level of goals and processing producing the most psychologically advantageous outcomes. Although previous research suggests that short-term confrontations with death may lead to defensiveness, the current studies suggest that encountering death over a longer period or in a manner consistent with goal structure may lead individuals to transcend defensiveness and maintain intrinsic goals or become more intrinsically oriented.

The role of social cognitive processing theory and optimism in positive psychosocial and physical behavior change after cancer diagnosis and treatment.

The physical and psychosocial 'health' behaviors of cancer patients have become a more pressing issue as 5-year survival rates continue to rise. This study investigated: (a) the extent of positive change in four psychosocial behaviors and two physical health behaviors, (b) the role of psychosocial predictors (drawn from theories of Social Cognitive Processing and optimism) in positive behavior change after cancer diagnosis and treatment, and (c) the possible influence of social desirability in reports of positive psychosocial and physical behavior change. The behavior showing the greatest positive change was time spent reflecting on life priorities; the behavior that was least likely to change after diagnosis and treatment was exercise. Optimism, social support, and cancer-related intrusions were positively associated with increases in physical health behaviors. Only optimism was positively associated with increases in psychosocial behaviors. Reports of positive change in physical and psychosocial behaviors were only modestly correlated. Social desirability was unrelated to reports of positive behavior change. Results are interpreted in light of theories of adaptation to cancer diagnosis and treatment.