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Yager J, Kay J. Purpose in Life: Addressing Transdiagnostic Psychopathologies Concerning Patients' Sense of Purpose. J Nerv Ment Dis 2023; 211:411-418. [PMID: 37094572 DOI: 10.1097/nmd.0000000000001657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
ABSTRACT Having a purpose in life is strongly associated with well-being and quality of life. Some individuals develop their sense of purpose early in life and can sustain lifelong ideals. In contrast, we identify four transdiagnostic syndromes where purpose in life is impaired: 1) deficiencies in generating purpose; 2) loss of purpose due to traumatic events such as catastrophic illnesses or bereavements; 3) conflicts due to crossed purposes; and 4) maladaptive purposes, such as life-limiting single-minded goals, dominating others, or exacting revenge. Several psychotherapies associated with positive and existential psychologies help patients construct, reconstruct, or retain a sense of purpose. However, given the strong links between a sense of purpose and beneficial health and mental health outcomes, the authors suggest that many patients in psychiatric treatment including psychotherapies will benefit from attention to these issues. This article reviews approaches for assessing and addressing purpose in life in psychiatric treatment, to enhance patients' healthy sense of purpose where this characteristic is impaired.
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Affiliation(s)
- Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Jerald Kay
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
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Young T, Pakenham KI, Chapman CM, Edwards MR. Predictors of mental health in aid workers: meaning, resilience, and psychological flexibility as personal resources for increased well-being and reduced distress. DISASTERS 2022; 46:974-1006. [PMID: 34617612 DOI: 10.1111/disa.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Aid workers operate in stressful environments and tend to experience high psychological distress, yet not enough is known about their well-being and how to improve their mental health. This research project surveyed 243 aid workers in 77 countries undertaking humanitarian and development work who reported lower well-being and higher psychological distress than the general population. Well-being and distress emerged as two related but distinct mental health outcomes, encouraging further research on well-being in the sector. Better mental health outcomes were predicted by the presence of meaning, psychological flexibility, and resilience. Presence of meaning was the strongest predictor, whereas resilience was the weakest. Meaning was a stronger predictor of good mental health among national workers, whereas psychological flexibility was a stronger predictor among female, older, and international workers. These results can support evidence-based approaches to staff care and mental health interventions for aid workers, expanding the current focus on resilience to include meaning and psychological flexibility.
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Affiliation(s)
- Tarli Young
- Postdoctoral Research Fellow at the School of Psychology, The University of Queensland, Australia
| | - Kenneth I Pakenham
- Emeritus Professor at the School of Psychology, The University of Queensland, Australia
| | - Cassandra M Chapman
- Lecturer in Marketing at the UQ Business School, The University of Queensland, Australia
| | - Martin R Edwards
- Associate Professor in Management at the UQ Business School, The University of Queensland, Australia
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The Effects of Logotherapy on Distress, Depression, and Demoralization in Breast Cancer and Gynecological Cancer Patients: A Preliminary Study. Cancer Nurs 2021; 44:53-61. [PMID: 31469671 DOI: 10.1097/ncc.0000000000000740] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Globally, cancer is the second leading cause of death. Breast cancer and gynecological cancer can damage patients' body image and lead to psychological distress, depression, and demoralization syndrome. No studies have explored the effect of logotherapy in gynecological cancer patients' psychological distress, depression, and demoralization. OBJECTIVE To evaluate the effects of logotherapy on distress, depression, and demoralization in breast cancer and gynecological cancer patients. METHODS A quasi-experimental design was used in this study, involving 61 breast cancer and gynecological cancer patients: 31 in the experimental group and 30 in the control group. Participants in the experimental group received logotherapy 4 to 6 times during the 12 weeks of intervention. Outcomes were measured by the (1) Distress Thermometer, (2) Patient Health Questionnaire, and (3) Demoralization Scale Mandarin Version (DS-MV). RESULTS Distress Thermometer did not differ between groups, but significant differences in favor of the intervention group were noted in the Patient Health Questionnaire (U = 674.500, P = .002); the DS-MV subcategories of loss of meaning (U = 706.500, P = .000), dysphoria (U = 673.000, P = .002), disheartenment (U = 670.000, P = .003), helplessness (U = 621.000, P = .022), and sense of failure (U = 629.500, P = .016); and the total score of the DS-MV (U = 728.500, P = .000). CONCLUSION Logotherapy was effective in the reduction of breast cancer and gynecological cancer patients' depression and demoralization. IMPLICATIONS FOR PRACTICE Clinical professionals could add logotherapy to the treatment for breast cancer and gynecological cancer patients to reduce their depression and demoralization.
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Chen Y, Xiao H, Zheng J, Zhang X, Lin X. Effects of a mind map-based life review programme on psychospiritual well-being in cancer patients undergoing chemotherapy: A randomised controlled trial. Eur J Cancer Care (Engl) 2020; 29:e13221. [PMID: 31908102 DOI: 10.1111/ecc.13221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/14/2019] [Accepted: 12/17/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the effects of a mind map-based life review programme (MBLRP) on psychological distress, hope, meaning in life and self-transcendence in cancer patients undergoing chemotherapy. METHODS Eighty-four cancer patients undergoing chemotherapy from a university-affiliated hospital in Fujian, China. The participants were randomly allocated to a MBLRP group (n = 40) or usual care group (n = 44). Data were collected at baseline (T0), on the second day (T1) and four weeks after the programme (T2) using the Distress Thermometer, Meaning in Life Questionnaire, Herth Hope Scale and Self-transcendence Scale. RESULTS No significant interaction effects for time and group membership were found for psychological distress either at T1 (t = -1.707, p = .090) or at T2 (t = -1.123, p = .263). The interaction effects for T1 and group membership were statistically significant for meaning in life (t = 3.487, p = .001) and hope (t = 5.313, p < .001), but not statistically significant for self-transcendence (t = 0.148, p = .882). The interaction effects for T2 and group membership were statistically significant for meaning in life (t = 2.592, p = .01), hope (t = 5.215, p < .001) and self-transcendence (t = 2.843, p = .005). CONCLUSIONS The MBLRP could improve hope, meaning in life and self-transcendence in cancer patients undergoing chemotherapy.
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Affiliation(s)
- Ying Chen
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Huimin Xiao
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jianwei Zheng
- Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaoling Zhang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xiaoyan Lin
- Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
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Jansen F, Lissenberg-Witte BI, Krebber AMH, Cuijpers P, de Bree R, Becker-Commissaris A, Smit EF, van Straten A, Eeckhout GM, Beekman ATF, Leemans CR, Verdonck-de Leeuw IM. Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: which groups specifically benefit? Secondary analyses of a randomized controlled trial. Support Care Cancer 2019; 27:4543-4553. [PMID: 30915569 PMCID: PMC6825034 DOI: 10.1007/s00520-019-04714-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/22/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Stepped care (SC), consisting of watchful waiting, guided self-help, problem-solving therapy, and psychotherapy/medication is, compared to care-as-usual (CAU), effective in improving psychological distress. This study presents secondary analyses on subgroups of patients who might specifically benefit from watchful waiting, guided self-help, or the entire SC program. METHODS In this randomized controlled trial, head and neck and lung cancer patients with distress (n = 156) were randomized to SC or CAU. Univariate logistic regression analyses were performed to investigate baseline factors associated with recovery after watchful waiting and guided self-help. Potential moderators of the effectiveness of SC compared to CAU were investigated using linear mixed models. RESULTS Patients without a psychiatric disorder, with better psychological outcomes (HADS: all scales) and better health-related quality of life (HRQOL) (EORTC QLQ-C30/H&N35: global QOL, all functioning, and several symptom domains) were more likely to recover after watchful waiting. Patients with better scores on distress, emotional functioning, and dyspnea were more likely to recover after guided self-help. Sex, time since treatment, anxiety or depressive disorder diagnosis, symptoms of anxiety, symptoms of depression, speech problems, and feeling ill at baseline moderated the efficacy of SC compared to CAU. CONCLUSIONS Patients with distress but who are relatively doing well otherwise, benefit most from watchful waiting and guided self-help. The entire SC program is more effective in women, patients in the first year after treatment, patients with a higher level of distress or anxiety or depressive disorder, patients who are feeling ill, and patients with less speech problems. TRIAL NTR1868.
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Affiliation(s)
- Femke Jansen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Anna M H Krebber
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Egbert F Smit
- Department of Pulmonary Diseases, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Guus M Eeckhout
- Department of Psychiatry, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
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Buonaccorso L, Martucci G, Miccinesi G, Maruelli A, Ripamonti C. Construction of new personal meanings by cancer patients: a qualitative analysis in an Italian patient population. Support Care Cancer 2018; 27:1911-1918. [DOI: 10.1007/s00520-018-4444-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/26/2018] [Indexed: 10/28/2022]
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Dibley L, Czuber-Dochan W, Woodward S, Wade T, Bassett P, Sturt J, Norton C. Development and Psychometric Properties of the Inflammatory Bowel Disease Distress Scale (IBD-DS): A New Tool to Measure Disease-Specific Distress. Inflamm Bowel Dis 2018; 24:2068-2077. [PMID: 29788323 DOI: 10.1093/ibd/izy108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) imposes a heavy psychosocial burden, with many patients reporting anxiety, depression, and distress. In diseases such as diabetes, disease-specific distress is associated with concordance with treatments and disease control. IBD distress, distinct from anxiety and depression, is evident in people with IBD. We aimed to develop a questionnaire for assessing IBD-specific distress, validate this against a gold standard distress measure for diabetes, and demonstrate the difference between anxiety, depression, and distress. METHODS The 94-item IBD Distress Scale (IBD-DS) was developed through secondary analysis of 3 qualitative data sets from previous IBD studies. Items were then refined through cognitive interviews in 2 stages (n = 15, n = 3). Three supplementary unscored questions were added to enable patients to identify their overall level of distress, their perceived level of disease activity, and their 3 most distressing issues. Subsequently, the 55-item IBD Distress Scale was subjected to test-retest. Two hundred seventy-five people received the test draft IBD-DS, and 168 responded (60.4%). Of these, 136 (82%) returned the retest draft of IBD-DS 3 weeks later. After analysis, further item reduction was informed by response rates, kappa values, and correlation coefficients, and test-retest was repeated. One hundred fifty-four people received the test final 28-item IBD-DS, and 123 people responded (58.8%). Of these, 95 (77%) returned the retest final IBD-DS. RESULTS The 94 items were reduced to 28 items. Good intraclass correlation (ICC) was found between test-retest scores on 72 complete data sets with unchanged disease status (ICC, 0.92; 95% confidence interval, 0.88-0.95). Cronbach's alpha was 0.95, indicating excellent internal consistency. Factor analysis indicated scoring the items as a single domain (score range, 0-168). CONCLUSION The final IBD-DS performs well and offers a tool for assessing IBD-specific distress.
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Affiliation(s)
- Lesley Dibley
- Faculty of Education and Health, University of Greenwich, London, United Kingdom.,Bart's Health NHS Trust, London, United Kingdom
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Sue Woodward
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Tiffany Wade
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Paul Bassett
- Independent Statistician, Amersham, United Kingdom
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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El-Jawahri A, Greer JA, Pirl WF, Park ER, Jackson VA, Back AL, Kamdar M, Jacobsen J, Chittenden EH, Rinaldi SP, Gallagher ER, Eusebio JR, Fishman S, VanDusen H, Li Z, Muzikansky A, Temel JS. Effects of Early Integrated Palliative Care on Caregivers of Patients with Lung and Gastrointestinal Cancer: A Randomized Clinical Trial. Oncologist 2017; 22:1528-1534. [PMID: 28894017 PMCID: PMC5728034 DOI: 10.1634/theoncologist.2017-0227] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/31/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The family and friends (caregivers) of patients with advanced cancer often experience tremendous distress. Although early integrated palliative care (PC) has been shown to improve patient-reported quality of life (QOL) and mood, its effects on caregivers' outcomes is currently unknown. MATERIALS AND METHODS We conducted a randomized trial of early PC integrated with oncology care versus oncology care alone for patients who were newly diagnosed with incurable lung and noncolorectal gastrointestinal cancers and their caregivers. The early PC intervention focused on addressing the needs of both patients and their caregivers. Eligible caregivers were family or friends who would likely accompany patients to clinic visits. The intervention entailed at least monthly patient visits with PC from the time of diagnosis. Caregivers were encouraged, but not required, to attend the palliative care visits. We used the Hospital Anxiety and Depression Scale (HADS) and Medical Health Outcomes Survey Short-Form to assess caregiver mood and QOL. RESULTS Two hundred seventy-five caregivers (intervention n = 137; control n = 138) of the 350 patients participated. The intervention led to improvement in caregivers' total distress (HADS-total adjusted mean difference = -1.45, 95% confidence interval [CI] -2.76 to -0.15, p = .029), depression subscale (HADS-depression adjusted mean difference = -0.71, 95% CI -1.38 to -0.05, p = .036), but not anxiety subscale or QOL at week 12. There were no differences in caregivers' outcomes at week 24. A terminal decline analysis showed significant intervention effects on caregivers' total distress (HADS-total), with effects on both the anxiety and depression subscales at 3 and 6 months before patient death. CONCLUSION Early involvement of PC for patients with newly diagnosed lung and gastrointestinal cancers leads to improvement in caregivers' psychological symptoms. This work demonstrates that the benefits of early, integrated PC models in oncology care extend beyond patient outcomes and positively impact the experience of caregivers. IMPLICATIONS FOR PRACTICE Early involvement of palliative care for patients with newly diagnosed lung and gastrointestinal cancers leads to improvement in caregivers' psychological symptoms. The findings of this trial demonstrate that the benefits of the early, integrated palliative care model in oncology care extend beyond patient outcomes and positively impact the experience of caregivers. These findings contribute novel data to the growing evidence base supporting the benefits of integrating palliative care earlier in the course of disease for patients with advanced cancer and their caregivers.
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Affiliation(s)
- Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse R Park
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony L Back
- Division of Oncology, Department of Medicine, University of Washington Seattle, Seattle, Washington, USA
| | - Mihir Kamdar
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliet Jacobsen
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eva H Chittenden
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Simone P Rinaldi
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily R Gallagher
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Justin R Eusebio
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah Fishman
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Harry VanDusen
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhigang Li
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Alona Muzikansky
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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