Dyadic coping mediates the effects of attachment on quality of life among couples facing ovarian cancer.

Cancer is an interpersonal stressor affecting both patient and spouse. To examine the pathways that insecure adult attachment can impact health outcomes by way of dyadic processes, this cross-sectional study used the actor-partner interdependence mediation model to examine whether common dyadic coping (CDC) mediated the associations between attachment and quality of life (QOL). Couples (N = 106) facing ovarian cancer were recruited from a comprehensive cancer center and completed self-report questionnaires. Results indicated that worse social and functional QOL were associated with both one's own and one's partner's greater insecure attachment, by way of one's own use of less CDC. Unexpectedly, greater CDC reported by one's partner was associated with one's own lower functional QOL. Although CDC has beneficial effects on QOL, CDC may also be experienced as draining. Effects of adult attachment on dyadic coping are a significant contributor to subjective health outcomes among couples facing ovarian cancer.

The Role of Posttraumatic Growth in a Randomized Controlled Trial of Cognitive-Behavioral Conjoint Therapy for PTSD.

Posttraumatic growth (PTG) is defined as a positive psychological change that can emerge following a traumatic life event. Although documented in noninterventional studies of traumatized individuals, there are scant data on the potential for therapy to induce or improve PTG. Thus, the primary goal of this study was to examine changes in PTG in a controlled trial of cognitive-behavioral conjoint therapy for posttraumatic stress disorder versus waitlist (CBCT for PTSD; Monson & Fredman, 2012). We also examined whether pretreatment relationship satisfaction and PTSD symptomatology moderated change in PTG. There were 40 couples (75% with a female partner with PTSD) who were randomized to either immediate CBCT for PTSD or a 3-month waitlist (WL). Compared to WL, individuals who received treatment immediately demonstrated a significant increase in PTG. There was a moderate effect size between-group difference (Hedge's g = 0.45). There was a nonsignificant relationship with a moderate effect size (Hedge's g = 0.65) for the positive effect of pretreatment relationship satisfaction on the trajectory of PTG, but no effect of pretreatment PTSD symptoms. Results suggested that CBCT for PTSD facilitated PTG, even with a limited focus on PTG in this conjoint intervention. Future research should target PTG as a treatment goal and further examine the role of close others in facilitating development of PTG.

Physician trust moderates the relationship between intolerance of uncertainty and cancer worry interference among women with Lynch syndrome.

This study investigated the extent to which intolerance of uncertainty was associated with cancer worry interference, anxiety and depression among women with Lynch syndrome (LS), and whether having greater trust in one's physician moderated those relationships. Women with confirmed LS (N = 128) were recruited from a high-risk of cancer registry and completed a one-time self-report questionnaire. Women who reported greater intolerance of uncertainty and more trust in their physician reported less cancer worry interference compared to women who had greater intolerance of uncertainty and less trust in their physician, who reported the highest worry interference, b = -1.39, t(99) = -2.27, p = .03. No moderation effect of trust in physician was found for anxiety or depression. Trust in one's physician buffered the impact of high intolerance of uncertainty on cancer worry interference, underscoring the need for supportive provider-patient relationships, particularly for LS patients.

An uncontrolled trial of a present-focused cognitive-behavioral conjoint therapy for posttraumatic stress disorder.

OBJECTIVE: The efficacy of a present-focused version of cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) was examined in a community sample. METHOD: Seven couples completed pretreatment assessments, including measures of clinician-, self- and partner-rated PTSD symptoms and relationship satisfaction. Six couples completed present-focused CBCT for PTSD and all posttreatment assessments. A seventh couple terminated their relationship prior to completing treatment; therefore, they completed posttreatment symptom measures, but not ratings of relationship satisfaction. RESULTS: Results revealed significant decreases in PTSD symptoms that were associated with medium-to-large effect sizes. Medium effect sizes for changes in relationship satisfaction were found, though were only significant for partners. CONCLUSION: Results from this pilot study suggest that present-focused CBCT for PTSD may be a promising alternative for individuals who are unwilling to engage in a trauma-focused treatment.

Fear of recurrence: the importance of self-efficacy and satisfaction with care in gay men with prostate cancer.

OBJECTIVE: Limited research has investigated the psychosocial processes that underpin the effect of physical symptoms on fear of cancer recurrence. Additionally, despite evidence of increased vulnerability of marginalized populations to negative outcomes, few studies have examined the unique experience of gay men coping with the cancer process. The goals of this study were to determine whether disease-related self-efficacy and satisfaction with medical care mediated the relationship between greater physical symptoms and worse fear of recurrence among gay or bisexual prostate cancer survivors. METHODS: Participants were composed of 92 self-identified gay or bisexual men, who had received a diagnosis of prostate cancer in the past 4 years. Participants provided demographic information and completed self-report questionnaires that assessed symptom function, self-efficacy for prostate cancer symptoms, satisfaction with healthcare, and fear of recurrence. Bootstrapping procedures were used to assess for significant mediation. RESULTS: Results suggested significant mediation of the relationship between each of bowel, hormonal, and sexual function with fear of recurrence by self-efficacy and satisfaction with healthcare. Mediation was not significantly supported for the association between urinary function and fear of recurrence. CONCLUSIONS: Findings support the explanatory effects of self-efficacy for symptom management and satisfaction with healthcare on the relationship between symptom function and fear of recurrence. These results indicate that psychological processes, specifically psychological factors that hold particular relevance to gay or bisexual men, reflect a potential avenue for intervention to decrease fear of cancer recurrence.

Development of multimedia informational tools for breast cancer patients with low levels of health literacy.

OBJECTIVE: To create informational tools for breast cancer patients with low levels of health literacy. METHODS: Tools were developed through a three-stage process. (1) Focus groups were conducted with breast cancer survivors and interviews were held with health educators to determine content, source of information, format and medium of the tools. (2) Based on this feedback, a suite of tools was developed. (3) Focus groups were reconvened and health educators re-interviewed to obtain feedback and determine satisfaction. RESULTS: We developed a suite of five informational tools using low health literacy principles, which focused on learning about breast cancer resources and learning about the members of one's healthcare team, understanding the "journey" or trajectory of care beginning at diagnosis, hearing from other breast cancer patients about their own journey, and becoming informed about what to expect pre-and post-surgery for breast cancer. The final products were rated highly by breast cancer survivors. CONCLUSION: The developed materials, designed for patients who read below an 8th grade level, reflect the informational needs reported by breast cancer patients. PRACTICE IMPLICATIONS: Healthcare providers must consider utilizing design principles and theories of adult learning appropriate for those with low health literacy.

Applied tension and coping with blood donation: a randomized trial.

BACKGROUND: Despite the ongoing need for blood donation, few people give blood. A common reason is concern about vasovagal symptoms. PURPOSE: The aim of this study was to evaluate the effectiveness of applied tension in reducing vasovagal symptoms during blood donation and the mechanisms of action. METHOD: Two hundred eighty-two young adult blood donors were randomly assigned to conditions involving applied tension during the pre-donation wait period, during the blood draw, both, or no applied tension at all. RESULTS: Applied tension was effective in reducing vasovagal symptoms in blood donors, particularly when practiced during the pre-donation wait period (p < 0.001). People who practiced applied tension during the pre-donation wait period required less treatment for vasovagal reactions than people who did not (8% vs. 16%). CONCLUSIONS: The results of this study suggest that the effects of applied tension on vasovagal symptoms are not mediated entirely by exercise-related changes in blood pressure and heart rate. Rather, it may reduce anxiety or physiological consequences of anxiety. Applied tension is a useful treatment which can help people cope during blood donation and other invasive medical interventions.

Moderators of cancer-related distress and worry after a pancreatic cancer genetic counseling and screening intervention.

OBJECTIVES: Although the hereditary breast and ovarian cancer literature has demonstrated short-term gains in psychological adjustment following genetic counseling, there has been limited research examining long-term outcomes and moderators. Moreover, there has been minimal research into the psychological effects of this intervention in populations at high risk for pancreatic cancer. This study examines the long-term effects of pancreatic cancer screening and genetic counseling on cancer-related distress and cancer worry in a high-risk population at 1-year follow-up. Additionally, this study explores potential moderators of the effectiveness of this intervention. METHODS: One hundred twenty-nine participants with familial pancreatic cancer or with the BRCA2 gene mutation completed a baseline questionnaire prior to their first pancreatic cancer screening and genetic counseling session. Participants also completed questionnaires at 3- and 12-month follow-up. RESULTS: Cancer-related intrusive thoughts decreased significantly over time, whereas cancer-related worry decreased at 3 months and showed a small but significant increase at 1 year. Age and baseline distress exhibited moderator effects. Younger individuals showed a significant decrease in cancer-related intrusive thoughts, cancer-related avoidant thoughts, and cancer worry. Additionally, individuals with greater baseline distress showed a significant decrease in cancer-related intrusive thoughts over time. CONCLUSIONS: Analysis of the long-term effects of pancreatic cancer screening and genetic testing reveal psychological gains that are maintained at 1-year follow-up. This intervention is particularly effective for younger participants and individuals with greater baseline distress.