Development and validation of an instrument to measure the impact of genetic testing on self-concept in Lynch syndrome.

A positive genetic test result may impact on a person's self-concept and affect quality of life. The purpose of the study was to develop a self-concept scale to measure such impact for individuals carrying mutations for a heritable colorectal cancer Lynch syndrome (LS). Two distinct phases were involved: Phase 1 generated specific colorectal self-concept candidate scale items from interviews with eight LS carriers and five genetic counselors, which were added to a previously developed self-concept scale for BRCA1/2 mutation carriers, Phase II had 115 LS carriers complete the candidate scale and a battery of validating measures. A 20-item scale was developed with two dimensions identified through factor analysis: stigma/vulnerability and bowel symptom-related anxiety. The scale showed excellent reliability (Cronbach's α = 0.93), good convergent validity by a high correlation with impact of event scale (r(102) = 0.55, p < 0.001) and Rosenberg self-esteem scale (r(108) = -0.59, p < 0.001), and a low correlation with the Fear questionnaire (r(108) = 0.37, p < 0.001). The scale's performance was stable across participant characteristics. This new scale for measuring self-concept has potential to be used as a clinical tool and as a measure for future studies.

A supportive-expressive group intervention for women with a family history of breast cancer: results of a phase II study.

BACKGROUND: Evidence suggests that there are significant psychological and behavioural sequelae associated with having a family history of breast cancer (BC) which can interfere with comprehension of risk estimates. PURPOSE: The purpose of this study was to develop, standardize and do preliminary testing of a group intervention designed to address the emotional impact of having a family history of BC. METHODS: This study is a single-arm pilot design with pre- and post-measures of perceived risk, psychosocial distress, knowledge and screening practices. RESULTS: The primary study outcome measure of risk comprehension was significantly improved by 70%, according to our predetermined criteria for success. In addition, the most important secondary measures of psychosocial functioning, such as cancer-related distress (p=0.025), depression (p=0.05), anxiety (p=0.005) and unresolved grief (p=0.034) were significantly improved. CONCLUSION: The results of this initial pilot study are encouraging; however, further research is required, using a randomized controlled study design to evaluate the relative contribution of this intervention to the successful modification of risk comprehension, enhanced psychological functioning, and to promote optimal screening adherence.

Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome.

OBJECTIVE: The purpose of this study was to investigate the presence of emotional abuse and two psychosocial constructs (self-blame and self-silencing) in a sample of women diagnosed with irritable bowel syndrome (IBS) relative to a comparison sample of women diagnosed with inflammatory bowel disease (IBD). METHODS: Women diagnosed with IBS (N = 25) were compared with women diagnosed with IBD (N = 25) on measures of history of abuse, self-blame, and self-silencing. RESULTS: It was found that women in the IBS sample scored significantly higher on emotional abuse, self-blame, and self-silencing than did women in the IBD sample. These three variables were also found to be significantly intercorrelated in both the IBS and IBD samples. Finally, emotional abuse was significantly higher in IBS patients than in IBD patients beyond the differences accounted for by physical and/or sexual abuse history. CONCLUSIONS: These findings empirically demonstrate an association between IBS and emotional abuse, as well as a possible connection with psychosocial variables, that may mediate the connection between emotional abuse and functional bowel symptoms. We suggest that these variables be further evaluated in the context of clinically relevant research on IBS.

The effects of the ideal of female beauty on mood and body satisfaction.

OBJECTIVE: The present study examined changes in women's mood states resulting from their viewing pictures in fashion magazines of models who represent a thin ideal. METHOD: Female university students completed the Profile of Mood States (POMS), the Body Parts Satisfaction Scale (BPSS), and the Eating Disorder Inventory (EDI). They were then exposed to 20 slides; the experimental group (N = 51) viewed images of female fashion models and a control group (N = 67) viewed slides containing no human figures. All subjects then completed the POMS and the BPSS again. RESULTS: Women were more depressed (R2 = 0.745, p < .05) and more angry (R2 = 0.73, p < .01) following exposure to slides of female fashion models. DISCUSSION: Viewing images of female fashion models had an immediate negative effect on women's mood. This study, therefore, supports the hypothesis that media images do play a role in disordered eating.

Features of eating disorders in patients with irritable bowel syndrome.

The relationship between characteristics of irritable bowel syndrome (IBS) and eating disorders (ED) was investigated in a clinical sample of 43 female and 17 male IBS patients who completed the Eating Disorder Inventory (EDI). A diagnosis of IBS was generally unrelated to the Body Dissatisfaction, Perfectionism, and Ineffectiveness subscales of the EDI, but symptom severity was correlated with Perfectionism and Ineffectiveness. Severe bouts of vomiting were significantly associated with desires for lower body weight and reported binge-purge behaviors and cognitions measured by the Bulimia subscale of the EDI. Results suggest the need for a more comprehensive understanding of both types of illness as well as a possible framework for future empirical work.

The development of a cognitive scale for functional bowel disorders.

OBJECTIVE: The importance of psychosocial factors in patients with Functional Bowel Disorders (FBD) has been well-established. However, most psychosocial measures used in research with FBD patients were not designed or validated on this population. A recent international team report recommended that psychosocial measures be developed to increase our understanding and treatment of FBD. The purpose of this study was to develop a reliable and valid instrument designed specifically to assess cognitions of patients with FBD. METHOD: An initial set of 204 scale items was generated from a large pool of thought diaries from patients diagnosed with FBD. Items were additionally refined using several methods, including consultation with a multidisciplinary team of international experts on FBD. The remaining 95 items were administered, along with a set of validating questionnaires, to a new sample of 75 FBD patients in Canada and the United States. RESULTS: The findings indicate that the final 25-item scale has high reliability (Cronbach's alpha = .93; inter-item correlation = .36); high concurrent criterion validity evidenced by the correlation of the scale with a global rating of life interference caused by bowel symptoms (r = .71; p<.001); acceptable convergent validity evidenced by the correlation of the scale with the Dysfunctional Attitudes Scale (r = .38; p<.01); high content validity and face validity; and minimal social desirability contamination (r = .15; NS). CONCLUSIONS: The Cognitive Scale for Functional Bowel Disorders is a valid and reliable scale that can be used as an outcome measure in evaluating the efficacy of different forms of psychotherapeutic intervention for FBD, and can also serve as a helpful assessment tool for health professionals working with patients diagnosed with FBD.

Cognitive-behavioral group therapy for patients with irritable bowel syndrome.

This article is divided into two parts, the first of which focuses on a general overview of irritable bowel syndrome (IBS) and provides a rationale for the use of cognitive-behavioral therapy (CBT) for IBS based on both theoretical and research perspectives. This section includes a critical review of CBT therapies for IBS and provides a model of CBT for IBS. The second section provides the clinician with practical information concerning the application of cognitive-behavioral group therapy for IBS. Possible scripts and case examples are incorporated into this section to highlight factors that may arise in working with IBS patients relative to other clinical groups. The second section also contains themes that are suggested content areas for group sessions. Contingent on the formulation of the presenting or emerging issues and goals, the order and inclusion of themes can be changed to fit the particular needs of a given group. Finally, this section provides initial preliminary data from a randomized controlled study that is suggestive of the efficacy of cognitive-behavioral therapy for IBS.