The Role of Metacognitions in Expressed Emotion and Distress: A Study on Caregivers of Persons with First-Episode Psychosis

Association of Rumination and Metacognition with Posttraumatic Growth in Parents of Children with Cancer

OBJECTIVE

The primary objective of this study was to examine the association of rumination, metacognition, and posttraumatic with growth in parents of children diagnosed with cancer.

DATA SOURCES

The study adopted a descriptive correlational design, and participants (N = 103) were parents of children with cancer. The study was conducted online through the social media platforms of three cancer associations. Data were collected using the Metacognitions Questionnaire-30, the Event Related Rumination Inventory, and the Posttraumatic Growth Inventory.

CONCLUSION

The findings revealed a positive correlation between deliberate rumination and metacognition with posttraumatic growth, while a negative correlation was observed between intrusive rumination and posttraumatic growth. Furthermore, deliberate rumination, intrusive rumination, and metacognition collectively accounted for 30% of the variance in posttraumatic growth among parents of children with cancer. These results underscore the significant influence of rumination and metacognition in facilitating posttraumatic growth in this specific population. Consequently, interventions aimed at fostering deliberate rumination hold substantial potential for promoting posttraumatic growth among parents of children diagnosed with cancer.

IMPLICATIONS FOR NURSING PRACTICE

This research guides nurses in addressing rumination, metacognition, and posttraumatic growth in parents of children with cancer. By adopting a holistic approach, nurses can enhance parents' well-being and resilience in the face of a child's cancer diagnosis.

Family Caregivers' Trajectories of Distress While Caring for a Person With Serious Mental Illness

Serious mental illness (SMI) can significantly impact the lives of individuals and their families. These families often experience great emotional distress over time due to the early onset of SMI, which in turn leads to long-term trajectories and only partial recovery. However, we do not fully understand the emotional distress of family caregivers. Thus, our aim was to enrich the understanding of the lived experiences of family caregivers' emotional trajectories of distress while caring for persons with SMI. We conducted a secondary analysis using a hermeneutic approach to the narratives of seven family caregivers from a study on living with voices unheard by others. Participants' trajectories of emotional distress came forth as being thrust on an unpredictable, intensely worrisome, and indefinite journey. The following themes highlighted this tumultuous journey: fumbling in the dark trying to grasp the incomprehensible, "on your toes"-enduring unpredictability, facing different forms of fear, and battling waves of sadness and regret. Caregivers face multiple threats to their well-being and sometimes even to their health. Their distress appeared to vary according to their relationship with the person with SMI, whether they lived with the ill person, illness trajectory, and amount of violent or suicidal behavior. The results underscore the need for individualized and timely information, opportunities for dialogue with healthcare providers with and without the person with SMI, and inclusion in care planning. Caregivers who have experienced trauma, threats of violence, and rejection require special attention.

Do carers of adolescents at first episode psychosis have distinctive psychological needs? A pilot exploration

BACKGROUND

Carers of patients experiencing first episode psychosis (FEP) are at an increased risk of mental and physical health problems themselves. However, little is known about how the psychological needs of carers may differ between those caring for an adolescent versus an adult who has FEP.

AIMS

This pilot study aimed to explore any differences in the psychological needs of carers caring for adolescents versus adults with FEP.

METHODS

We surveyed 254 carers of 198 FEP patients (34 carers of adolescents of 24 FEP adolescent patients). Carers completed self-report measures of anxiety, depression, burnout, subjective burden, coping, and key illness beliefs. The sample was divided according to whether the patient was under (adolescent) or over (adult) age 18, and analysed using mixed model logistic regressions.

RESULTS

Compared to the carers of adult patients, carers of adolescents were more than twice as likely (12% vs. 30%) to experience overall burnout syndrome (all three domains), and to develop it much quicker (19.4 vs. 10.1 months). They were also more likely to adopt behavioural disengagement avoidance as a form of coping. However, there was no difference between carers in terms of anxiety, depression, beliefs and subjective burden. For carers of adolescents, burnout was independently predicted by: a negative belief about the consequences of psychosis for the adolescent patient and an incoherent understanding of the patient's mental health.

CONCLUSIONS

If our findings can be replicated in a larger sample, then Rapid-Onset-Burnout-Syndrome (ROBS) is a particular problem in carers of adolescents at FEP, suggesting a need for routine screening and possible prophylactic intervention. Carers of adolescent's use of behavioural escape coping maybe also require early intervention. Theoretically, consideration could be given to the development of an adolescent sub-branch to the cognitive model of caregiving.

Psychological Resilience, Metacognitions, and Fear of Recurrence Among Cancer Survivors and Family Caregivers

BACKGROUND

Cancer is a life crisis that can have devastating consequences not only on the affected individual but also on his/her caregivers.

OBJECTIVE

The aim of this study was to investigate the influence of psychological resilience and metacognitions of cancer survivors and their family caregivers (FCs) on fear of recurrence (FoR).

METHODS

This study used a cross-sectional design while adhering to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Data were collected from 112 cancer survivors and 112 FCs recruited from 5 oncology hospitals.

RESULTS

The cancer survivors and caregivers reported low levels of psychological resilience, which we found to be correlated with great fear of recurrence in cancer survivors and FCs. It was also in relation with metacognitions in cancer survivors and FCs.The findings showed that psychological resilience negatively predicted the fear of recurrence, whereas the metacognitions positively predicted the fear of recurrence in cancer survivors and FCs. The total effects of psychological resilience on the FoR in cancer survivors and FCs were 0.920 (confidence interval [CI], -2.059 to 0.072) and 0.061 (CI, -0.475 to 0.474), respectively. The total effects of metacognition on the FoR in cancer survivors and FCs were 1.164 (CI, 0.217-2.371) and 0.486 (CI, 0.016-1.058), respectively.

CONCLUSIONS

The findings underline the direct and indirect mediating role of psychological resilience and metacognition of cancer survivors and FCs on FoR.

IMPLICATION FOR PRACTICE

The findings are particularly important to oncology nurses, who as 24-hour care providers are important sources of psychosocial care. Their awareness of factors influencing FoR is critical for achieving positive outcomes.

"Technically well, but not really": carers' constructions of recovery from psychosis

Background: The recovery movement has become highly influential in research and services for people who experience psychosis. However, the precise meaning of recovery from psychosis is contested, and there are concerns that the language of the recovery movement may be co-opted to serve other priorities.Aims: To investigate carers' constructions of the meaning of recovery from psychosis.Method: A qualitative study, using synthetic discursive psychology to analyse transcripts of semi-structured interviews with seven carers recruited from an Early Intervention in Psychosis service, where recovery approaches were practised.Results: We found medical accounts of recovery to be highly influential used both frequently and as a key reference point, even when describing alternative, non-medical accounts of recovery. Such alternative accounts of recovery in the data were fragementary and participants tended to use such accounts to signal some kind of trouble or disruption.Conclusions: Explanations of the objectives of recovery approaches cannot escape comparison with a medical repertoire of recovery. Such explanations may benefit from illustration using personal accounts of recovery that contain concrete detail. Creating conditions of safe uncertainty around the meaning of recovery may be an important aim for clinicians and services.

Psychological Flexibility as a Buffer against Caregiver Distress in Families with Psychosis

Background: Research has shown that caregivers of persons with psychosis play an invaluable role in recovery, but unfortunately, often report high levels of distress. While cognitive models of caregiver distress have been well-supported, there is still limited knowledge of the psychological factors involved. Recent advances in cognitive behavioral therapy seem to converge on the importance of acceptance- and mindfulness based processes.

Aim: To examine the impact of psychological flexibility on caregiver distress in the early phases of psychosis, while controlling for known predictors of caregiver distress.

Method: Within a cross-sectional design, 101 caregivers of 38 persons with first-episode psychosis in a clinical epidemiological sample completed a series of self-report measures.

Results: A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service user symptoms, drug use and global functioning, psychological flexibility was a significant predictor of caregiver distress.

Conclusion: Greater level of psychological flexibility in caregivers, seems to be related to lower levels of caregiver distress. This finding corresponds to studies within a broad range of emotional disorders. There may be important clinical implications in terms of facilitating the process of acceptance through interventions from the ‘third-wave’ or contextual cognitive behavioral therapies.

Criticism and Depression among the Caregivers of At-Risk Mental State and First-Episode Psychosis Patients

Expressed emotion (EE), especially criticism, is an important predictor of outcomes for the patient for a wide range of mental health problems. To understand complex links between EE and various relevant variables in early phase psychosis, this study examined criticism, distress of caregivers, other patients’, and caregivers’ variables, and links between criticism and these variables in those with at-risk mental state (ARMS) for psychosis and first-episode psychosis (FEP). The participants were 56 patients (mean age 18.8 ± 4.2 years) with ARMS and their caregivers (49.4 ± 5.8 years) and 43 patients (21.7 ± 5.2 years) with FEP and their caregivers (49.3 ± 7.4 years). We investigated criticisms made by caregivers using the Japanese version of the Family Attitude Scale and caregiver depressive symptoms via the self-report Beck Depression Inventory. We also assessed psychiatric symptoms and functioning of the patients. Approximately one-third of caregivers of patients with ARMS or FEP had depressive symptoms, predominately with mild-to-moderate symptom levels, whereas only a small portion exhibited high criticism. The level of criticism and depression were comparable between ARMS and FEP caregivers. The link between criticism, caregivers’ depression, and patients’ symptoms were observed in FEP but not in ARMS caregivers. These findings imply that the interaction between criticism and caregivers’ and patients’ mental states may develop during or after the onset of established psychosis and interventions for the caregivers should be tailored to the patient’s specific stage of illness. Interventions for FEP caregivers should target their emotional distress and include education about patient’s general symptoms.

Caregiver distress in first-episode psychosis: the role of subjective appraisal, over-involvement and symptomatology

BACKGROUND

Caregivers of persons with first-episode psychosis (FEP) often report high levels of distress. Preventing long-term or chronic distress within the whole family is an important focus of early intervention for psychosis. However, a more comprehensive understanding of the psychological factors involved is needed.

AIMS

To examine the impact of subjective appraisals and expressed emotion on caregiver distress in FEP.

METHOD

Within a cross-sectional design, 154 caregivers of 99 persons with FEP in a clinical epidemiological sample completed a series of questionnaires to examine potential predictors of caregiver distress.

RESULTS

Thirty-seven percent of caregivers were suffering from clinically significant distress. A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service-user symptoms and global functioning, emotional over-involvement and subjective appraisal of caregiving were significant predictors of caregiver distress.

CONCLUSION

Caregiver distress is significant in the early phase of illness, and this seems to be more related to their subjective appraisal and over-involvement, than to variations in symptoms and global functioning of the person diagnosed with FEP. This lends further support to the stress-appraisal coping model and the cognitive model of caregiving in FEP, and highlights supportive interventions aimed at handling unhelpful cognitions and behaviors.

Service user perspectives on the experience of illness and pathway to care in first-episode psychosis: a qualitative study within the TOP project

Delays in initiating treatment are associated with poor clinical and functional outcomes, yet there remains unclarity as to what facilitates and what acts as barriers to accessing appropriate support for first-episode psychosis. To explore this we examined service users' views of their illness trajectory and help-seeking behavior. To describe service-users' experiences with and understanding of their illness and pathway to care, including their need for treatment, the role of their relatives and experience with the treatment service. In-depth interviews were conducted with eleven randomly selected service users (median age 20, range 15-24, 6 males, 5 females) diagnosed with a first-episode psychosis and currently enrolled in treatment for this disorder. Fear of stigma, lack of knowledge about mental illness and normalisation of symptoms were barriers to accessing appropriate treatment, while support from significant others and information accessed by internet were reported as important elements in seeking appropriate treatment. The findings regarding barriers to treatment are in accordance with themes found in earlier studies and serve to validate these. Our study highlights the need to include psychological factors such as normalisation of symptoms and fear of stigma when attempting to reduce DUP in early psychosis, in addition to initiatives to reduce service delays. Also, a greater use of the potentials inherent in Internet and social media platforms seems important in this regard.