Measuring double awareness in patients with advanced cancer: A preliminary scale development study.

BACKGROUND: Individuals with advanced cancer face the challenge of living meaningfully while also preparing for end of life. The ability to sustain this duality, called "double awareness," may reflect optimal psychological adaptation, but no psychometric scale exists to measure this construct. OBJECTIVES: The purpose of this study was to develop a novel scale to measure double awareness in patients living with advanced cancer. METHODS: Guided by best practices for scale development, this study addresses the first three of nine steps in instrument development, including domain clarification and item generation, establishment of content validity of the items, and pre-testing of the items with patients. RESULTS: Instrument development resulted in a 41-item measure with two dimensions titled "life engagement" and "death contemplation." Items retained in the measure displayed face validity and were found to be both acceptable by patients and relevant to their lived experience. SIGNIFICANCE OF RESULTS: The results of this scale development study will allow for full validation of the measure and future use in clinical and research settings. This novel measure of double awareness will have clinical utility and relevance in a variety of settings where patients with advanced cancer are treated.

Developing an ACT-based intervention to address lung cancer stigma: Stakeholder recommendations and feasibility testing in two NCI-designated cancer centers.

Objective: Few psychosocial interventions have been tailored to meet the unique needs of patients diagnosed with lung cancer. This pilot study developed and tested a six-week intervention for reducing lung cancer stigma.Design and Subjects: Guided by qualitative interviews conducted with 9 lung cancer patients and 5 thoracic oncology care providers, Acceptance and Commitment Therapy was adapted for treatment of lung cancer stigma (ACT-LCS). In a subsequent single arm pilot study, 22 lung cancer patients reporting high levels of stigma completed the intervention.Setting: NCI-designated cancer centers in the Southwestern and Eastern United States.Results: Of 46 eligible patients, 22 provided consent, with 20 completing the intervention (10 in-person, 10 telehealth). Overall stigma decreased across timepoints, largely driven by reductions in internalized stigma. There were also significant reductions in social isolation, sleep disturbance, and fatigue.Conclusions: The ACT-LCS protocol demonstrates preliminary feasibility and acceptability. This intervention may be particularly suited for helping patients navigate feelings associated with internalized stigma.

A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single-arm pilot study.

OBJECTIVE: Apply the National Institutes of Health (NIH) Stage Model to design and test an intervention to prevent depression in breast cancer patients at risk for depression. METHODS: We identified mindful emotion awareness, along with approach and avoidance strategies for cancer-related coping and emotion regulation, as targets for a preventive intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Patients' preferences for individual, in-person, and time-efficient sessions informed the design. Patients at risk for depression received a 6-week, 5-hour intervention with daily exercises. Intervention targets were assessed at baseline, before each session, and 4-weeks post intervention. Mixed effects analysis of variance (ANOVA) assessed change over the follow-up period, controlling for age, partnered status, and disease stage. RESULTS: Fifty-five percent (40/72) of women screened within 6 months of diagnosis had elevated depression risk. Of these, 24 (60%) signed consent. Sixteen received intervention after five were excluded for current depressive disorder, cognitive impairment, or death. Three dropped out. Ninety-eight percent attendance and 77% practice days indicated feasibility. Effect sizes (Cohen's d) corrected for regression to the mean (RTM) were 0.82 for cancer-related acceptance coping, 0.65 for cancer-related emotional expression, and 0.32 and 0.42 for decreased cancer-related avoidance coping and depressive symptoms, respectively. Effect sizes for variables lacking data to correct for RTM were 1.0, 0.7, and 0.5 for decreased rumination, experiential avoidance, and fear of depression, respectively, and 1.3, 0.6, and 0.4 for increased cognitive flexibility, distress tolerance, and describing/not judging emotions, respectively. CONCLUSIONS: The feasibility of this intervention and malleability of its targets support its further investigation.

Yearning predicts subgenual anterior cingulate activity in bereaved individuals.

Complicated grief, or persistent complex bereavement disorder, is a condition that affects approximately 10% of bereaved individuals and is marked by intense longing and yearning for the deceased. Little is known about the neurocognitive mechanisms contributing to this syndrome, but previous research suggests that reward pathways in the brain may play a role. Twenty-five older adults were categorized based on grief severity into one of three groups: complicated grief (CG), non-complicated grief (NCG) and non-bereaved married controls (NB). Neural activation was examined using fMRI while participants viewed a countdown on the screen (anticipation) followed by a photo of their (living or deceased) spouse. There was no significantly differential activation between the three groups for the spouse v. stranger photo contrast, nor for anticipation period v. spouse photo. Post-hoc analyses were conducted using self-reported yearning scores as a regressor across all bereaved participants, which revealed that greater symptoms of yearning predicted greater activation in the subgenual anterior cingulate cortex (sgACC). Given the small sample size, the results should be considered preliminary and in need of replication, but may suggest a more nuanced, transdiagnostic role of the sgACC. This region of the brain has been previously linked to depression and suggests that symptoms of yearning may present an opportune place to intervene to improve outcomes in CG.

The Vivid Present: Visualization Abilities Are Associated with Steep Discounting of Future Rewards.

Humans and other animals discount the value of future rewards, a phenomenon known as delay discounting. Individuals vary widely in the extent to which they discount future rewards, and these tendencies have been associated with important life outcomes. Recent studies have demonstrated that imagining the future reduces subsequent discounting behavior, but no research to date has examined whether a similar principle applies at the trait level, and whether training visualization changes discounting. The current study examined if individual differences in visualization abilities are linked to individual differences in discounting and whether practicing visualization can change discounting behaviors in a lasting way. Participants (n = 48) completed the Vividness of Visual Imagery Questionnaire (VVIQ) and delay discounting task and then underwent a 4-week intervention consisting of visualization training (intervention) or relaxation training (control). Contrary to our hypotheses, participants who reported greater visualization abilities (lower scores) on the VVIQ were higher discounters. To further examine this relationship, an additional 106 participants completed the VVIQ and delay discounting task. In the total sample (n = 154), there was a significant negative correlation between VVIQ scores and discount rates, showing that individuals who are better visualizers are also higher discounters. Consistent with this relationship but again to our surprise, visualization training tended, albeit weakly, to increase discount rates, and those whose VVIQ decreased the most were those whose discount rates increased the most. These results suggest a novel association between visualization abilities and delay discounting.