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Zhou X, Guo J, Wu H, Chen D, Wang C, You J. The Relationship between Ambivalence over Emotional Expression and Nonsuicidal Self-Injury Among Chinese Adolescents: A Longitudinal Moderated Mediation Model. Arch Suicide Res 2024; 28:90-106. [PMID: 36282550 DOI: 10.1080/13811118.2022.2134068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) has become a significant mental health concern for adolescents. Previous empirical studies have shown that ambivalence over emotional expression is positively associated with negative emotions and behaviors. However, little is known about the relationship between ambivalence over emotional expression and NSSI among adolescents. Therefore, this study used a longitudinal design to examine the relationship between ambivalence over emotional expression and NSSI among Chinese adolescents, and also to explore the mediating and moderating mechanisms underlying this relationship. METHOD A total of 1,672 students (45.8% males; Mage = 16.12 years, SD = 1.56) in a middle school in Guangzhou were tracked. The investigation was conducted twice, with an interval of 6 months. RESULTS Ambivalence over emotional expression was positively correlated with NSSI. After controlling for gender and baseline NSSI, anxiety symptoms fully mediated the association between ambivalence over emotional expression and NSSI. In addition, the relationship between ambivalence over emotional expression and NSSI was moderated by NSSI refusal self-efficacy. CONCLUSIONS These findings imply that to decrease ambivalence over emotional expression, to reduce anxiety symptoms, and to promote NSSI refusal self-efficacy may be useful for interventions and preventions of NSSI.HIGHLIGHTSTested the relationship between ambivalence over emotional expression and NSSI in adolescents.Examined a moderated-mediation model over six months.Found the mediated effect of anxiety symptoms and moderated effect of NSSI refusal self-efficacy in the relationship between ambivalence over emotional expression and NSSI.
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Wu Y, Yang D, Jian B, Li C, Liu L, Li W, Li X, Zhou C. Can emotional expressivity and writing content predict beneficial effects of expressive writing among breast cancer patients receiving chemotherapy? A secondary analysis of randomized controlled trial data from China. Psychol Med 2023; 53:1527-1541. [PMID: 34425924 DOI: 10.1017/s0033291721003111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND To explore whether emotional expressivity and the patterns of language use could predict benefits from expressive writing (EW) of breast cancer (BC) patients in a culture that strongly discourages emotional disclosure. METHODS Data were obtained from a recent trial in which we compared the health outcomes between a prolonged EW group (12 sessions) and a standard EW group (four sessions) (n = 56 per group) of BC patients receiving chemotherapy. The Chinese texts were tokenized using the THU Lexical Analyser for Chinese. Then, LIWC2015 was used to quantify positive and negative affect word use. RESULTS Our first hypothesis that BC patients with higher levels of emotional expressivity tended to use higher levels of positive and negative affect words in texts was not supported (r = 0.067, p = 0.549 and r = 0.065, p = 0.559, respectively). The level of emotional expressivity has a significant effect on the quality of life (QOL), and those who used more positive or fewer negative affective words in texts had a better QOL (all p < 0.05). However, no significant difference was identified in physical and psychological well-being (all p > 0.05). Furthermore, the patterns of affective word use during EW did not mediate the effects of emotional expressivity on health outcomes (all p > 0.05). CONCLUSIONS Our findings suggest that the level of emotional expressivity and the pattern of affective word use could be factors that may moderate the effects of EW on QOL, which may help clinicians identify the individuals most likely to benefit from such writing exercises in China.
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Affiliation(s)
- Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | | | - Biao Jian
- China Electronic Product Reliability and Environmental Testing Research Institute, Guangzhou, Guangdong, PR China
| | - Chaixiu Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Liping Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Wenji Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaojin Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
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Patwardhan N, Kulkarni M. Life’s Ups and Downs: Expressive Writing and Health Outcomes. PSYCHOLOGICAL STUDIES 2023. [DOI: 10.1007/s12646-022-00701-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Lu Q, Yeung NCY, Tsai W, Kim JHJ. The effects of culturally adapted expressive writing interventions on depressive and anxiety symptoms among Chinese American breast cancer survivors: A randomized controlled trial. Behav Res Ther 2023; 161:104244. [PMID: 36592575 PMCID: PMC11403477 DOI: 10.1016/j.brat.2022.104244] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/27/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Expressive writing interventions confer mental health benefits for non-Hispanic Whites. However, research is lacking in adapting this paradigm for minoritized groups. This study evaluated the impacts of two culturally adapted expressive writing interventions on depressive and anxiety symptoms and potential mediators (perceived stress and intrusive thoughts) among Chinese American breast cancer survivors (CABCS). METHODS AND RESULTS CABCS (N = 136) were randomly assigned to one of three conditions to write three weekly essays: enhanced self-regulation condition (ESR) to write about stress and coping (Week 1), deepest feelings (Week 2), and finding benefits (Week 3); self-regulation condition (SR) to write about deepest feelings (Week 1), stress and coping (Week 2), and finding benefits (Week 3); and control condition to write about facts relevant to their cancer experience (Weeks 1-3). Compared with the control condition, the ESR but not SR, reduced depressive and anxiety symptoms at all follow-up time points (1, 3, and 6-months) through reductions in perceived stress. CONCLUSION A cultural adaptation altering the order of expressive writing prompts resulted in the greatest benefit for CABCS' depressive and anxiety symptoms. Research testing both the content and ordering of components may be vital to advance cultural adaptation science and optimize intervention efficacy. CLINICAL TRIAL REGISTRATION NUMBER NCT02946619.
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Affiliation(s)
- Qian Lu
- Department of Health Disparities Research, the University of Texas MD Anderson Cancer Center, Houston, TX, USA. Address: 1400 Pressler St. Unit 1440, Houston, TX 77030-3906, USA.
| | - Nelson C Y Yeung
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong Address: Room 508, Postgraduate Education Centre, Prince of Wales Hospital, the New Territories, Hong Kong.
| | - William Tsai
- Department of Applied Psychology, New York University, New York, NY, USA: Address: 246 Greene Street 8th Floor, New York, NY 10003, USA.
| | - Jacqueline H J Kim
- Department of Medicine, University of California, Irvine, CA, USA. Address: 100 Theory, Suite 100, Irvine, CA 92617, USA.
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Filella G, Ros-Morente A. Happy Software: An interactive program based on an emotion management model for assertive conflict resolution. Front Psychol 2023; 13:935726. [PMID: 36710745 PMCID: PMC9881478 DOI: 10.3389/fpsyg.2022.935726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/31/2022] [Indexed: 01/15/2023] Open
Abstract
Emotions are key to conflict resolution: to resolve conflict situations assertively, we must be able to manage the emotions that cause them. After a detailed analysis of the relevant theoretical framework, this paper presents a theoretical emotion management model aimed at assertive conflict resolution. The model, which is described step by step, has been transformed into an interactive program for students, implemented, and assessed in a population aged 8-16 years. The model is divided into four steps or phases. The first is emotional awareness, which consists of understanding and legitimating emotions; the second focuses on reducing emotional intensity and impulsivity; the third encompasses the use of different emotion regulation strategies; and the fourth and final step is assertive communication. Training in this process results in better emotion management, which eventually leads to greater wellbeing and a more positive assessment of new conflicts and aids in the assertive resolution thereof. The final section of the paper summarizes the most important evidence and outcomes of the use of the Happy software so far.
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Abd Hadi NH, Midin M, Tong SF, Chan LF, Mohd Salleh Sahimi H, Ahmad Badayai AR, Adilun N. Exploring Malaysian parents' and teachers' cultural conceptualization of adolescent social and emotional competencies: A qualitative formative study. Front Public Health 2023; 11:992863. [PMID: 37033063 PMCID: PMC10076560 DOI: 10.3389/fpubh.2023.992863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/17/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Global implementation of social and emotional learning (SEL) has been suggested to incorporate a systematic cultural adaptation process which relies on ground-up empirical data of a target cultural group in tailoring a culturally sensitive SEL intervention. Preliminary formative studies among local parents and educators were done to explore the conceptualization of social and emotional competencies (SECs) in various cultural settings, such as the continent of Africa and among the indigenous and refugee groups. Unfortunately, little scholarship has been devoted to studying the SEL adaptation process in Southeast Asian regions. This formative study aimed to explore Malaysian parents' and teachers' cultural conceptualization of adolescent SECs. Methods This qualitative study interviewed 12 Malaysian parents and 10 Malaysian teachers comprising of Malay (82%), Chinese (9%) and Indian (9%) races in an online focus group discussion. Sampling is purposive to parents of adolescents and teachers at secondary school only. Data were analyzed thematically to determine the culturally sensitive SEL constructs for Malaysian adolescents. Results All themes and sub-themes of SEC regarded as crucial for Malaysian adolescents are aligned with CASEL's five domains of competencies. Our findings extended the conceptualization of subskills under CASEL's relationship skills and responsible decision-making domains, which reflect Asian cultural values. The main themes of social competency: (a) preserving interpersonal relationships, (b) utilizing intrapersonal skills, and (c) communicating effectively, are shared with the established CASEL constructs. However, the underlying subthemes denote the unique cultural manifestation of social competency in Malaysia. Two of the emotional competency themes represent the established CASEL constructs: (a) practicing self-regulation, (b) demonstrating help-seeking behavior, and the other two themes signify Asian values: (c) upholding altruism, and (d) maintaining cultural display rules. Discussions This formative study revealed the habitual use of experiential and expressive suppressions as adaptive emotion regulation strategies in Malaysian collectivist culture and offered a potential alternative emotion regulation pathway suitable for Malaysian adolescents. It also informed the feasibility of implementing SEL modules developed based on the CASEL framework in Malaysia and suggested two key lessons to enhance the cultural sensitivity of SEL in Malaysia: effective, respectful communication and expressive writing.
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Affiliation(s)
- Nur Hazwani Abd Hadi
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Marhani Midin
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
- *Correspondence: Marhani Midin
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Hajar Mohd Salleh Sahimi
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Abdul Rahman Ahmad Badayai
- Centre for Research in Psychology and Human Well-Being (PsiTra), Faculty of Social Sciences and Humanities, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Norsinar Adilun
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Getanda EM, Vostanis P. Feasibility evaluation of psychosocial intervention for internally displaced youth in Kenya. J Ment Health 2022; 31:774-782. [PMID: 32915670 DOI: 10.1080/09638237.2020.1818702] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND There is limited evidence on the cultural appropriateness of first-stage psychosocial interventions for youth with mental health problems who experience conflict and disadvantage in low- and middle-income countries (LMIC). AIMS To evaluate the feasibility of such an intervention (Writing for Recovery - WfR) among youth with emerging emotional problems following internal displacement in Kenya. METHOD Fifty-four youth aged 14-17 years were randomly allocated to a six-session intervention or a waiting list control group. They completed measures of stressful life events; post-traumatic stress, depressive and anxiety symptoms; quality of life; and free text on their experience of the intervention. RESULTS Young participants reported high levels of trauma exposure and emotional problems. The intervention was perceived as flexible and culturally acceptable, with reported short-term impact. This was found to have promising post-intervention effect in reducing post-traumatic stress, but not depressive or anxiety symptoms; and in enhancing quality of life scores. CONCLUSIONS Similar psychosocial interventions that can be delivered by paraprofessionals are important for resource-constrained LMIC settings, but need to be integrated within a comprehensive scaled service model.
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Affiliation(s)
| | - Panos Vostanis
- Child and Adolescent Mental Health, University of Leicester, Leicester, UK
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Batista J, Marinai JC, Gouveia M, Oliveira JT, Gonçalves MM. Write and Let Go: An Online Writing Program for University Students. Front Psychol 2022; 13:874600. [PMID: 35874340 PMCID: PMC9301038 DOI: 10.3389/fpsyg.2022.874600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background There are a plethora of studies on expressive writing and positive writing interventions, but few have addressed the combination of both paradigms. Additionally, research on the role of ambivalence toward change in the context of writing-based interventions is lacking. Ambivalence toward change is a natural movement of approaching and avoiding change that may occur in various situations. In psychotherapy, its resolution is associated with successful outcomes. Aim This study tested the efficacy of a combination of expressive and positive writing paradigms in an internet-based intervention to improve university students' mental health. Additionally, focusing participants on a current, unresolved problem allowed us to explore the possible role of ambivalence toward change as a mediator of the intervention's results. Methods We recruited 172 participants who were randomly divided into experimental (n = 85) and control (n = 87) groups. The intervention consisted of the identification of a current problem and four writing tasks on consecutive days. Assessment was conducted at baseline and posttest in both groups and at follow-up in the experimental group. Participants in the experimental condition were also assessed after each task. Measures of anxiety, depression, rumination, ambivalence toward change, distress, and wellbeing (optimism, affect, and satisfaction with life) were collected. Results Multivariate analysis of variance (MANOVA) showed that participants in the experimental group had a significant decrease from baseline to posttest in ambivalence toward change and rumination when compared with the control group. These results were maintained at follow-up. No differences were found in the remaining measures. Within the experimental group, ambivalence toward change, rumination, and distress significantly decreased throughout the intervention and the exploratory mediation analysis indicated that ambivalence toward change partially mediated the improvements in rumination and distress. Discussion Considering different perspectives about a current problem and using a combination of expressive and positive writing fostered the reduction of ambivalence toward change and rumination. Ambivalence toward change reduction after the second writing task may have created optimal conditions for the subsequent decrease in rumination and distress. Future studies should replicate this finding and dismantle the components that are more adequate in changing these variables.
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Kim HS, Chung MY, Rhee ES, Kim Y. Is it reciprocating or self-serving?: Understanding coping strategies for postpartum depression in an online community for Korean mothers. Health Care Women Int 2022; 43:1464-1481. [DOI: 10.1080/07399332.2022.2037604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hyang-Sook Kim
- Department of Mass Communication, Towson University, Towson, Maryland, USA
| | - Mun-Young Chung
- Department of Mass Communications, Bloomsburg University of Pennsylvania, Bloomsburg, Pennsylvania, USA
| | - Eun Soo Rhee
- Department of Mass Communication, Towson University, Towson, Maryland, USA
| | - Youjeong Kim
- School of Journalism and Mass Communication, Texas State University, San Marcos, Texas, USA
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Ji L, Wang J, Zhu B, Qiao X, Jin Y, Si H, Wang W, Bian Y, Wang C. Expressive suppression and rumination mediate the relationship between frailty and depression among older medical inpatients. Geriatr Nurs 2021; 43:293-298. [PMID: 34974398 DOI: 10.1016/j.gerinurse.2021.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Frailty is common among older medical inpatients and has been found to be an independent risk factor for depression. However, few studies have explored the underlying mechanisms of the frailty-depression relationship. The present study was aimed to examine emotional regulation strategies as mediators in the frailty-depression relationship based on the process model of emotional regulation. METHODS Older medical inpatients (N=684) completed questionnaires and tests on frailty, emotional regulation strategies, and depressive symptoms. RESULTS Structural equation models showed that expressive suppression and rumination, but not cognitive reappraisal, mediated the relationship between frailty and depressive symptoms (RMSEA = 0.059, CFI = 0.963, TLI = 0.957). CONCLUSIONS Frail older medical inpatients habitually use expressive suppression and rumination in their daily lives, which may lead to more psychological disturbance. Interventions targeting expressive suppression and rumination might be effective in reducing the detrimental effect of frailty on psychological well-being among older medical inpatients.
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Affiliation(s)
- Lili Ji
- School of Nursing, Peking University, 100191 Beijing, China; School of Nursing, Weifang Medical University, 261042 Weifang, China
| | - Jinrong Wang
- Affiliated Hospital of Weifang Medical University, 261031 Weifang, China
| | - Baoqi Zhu
- Affiliated Hospital of Weifang Medical University, 261031 Weifang, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, 100191 Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, 100191 Beijing, China
| | - Wenyu Wang
- School of Nursing, Peking University, 100191 Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, 100191 Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, 100191 Beijing, China.
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A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav 2021; 5:631-652. [PMID: 33875837 DOI: 10.1038/s41562-021-01093-w] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022]
Abstract
Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.
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Tsai W, Lee CS, Monte V. Comparing the effects of emotional disclosure and peer helping writing on psychological distress among Chinese international students: The moderating role of rumination. J Clin Psychol 2021; 77:1556-1572. [PMID: 33822363 DOI: 10.1002/jclp.23135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 03/07/2021] [Accepted: 03/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study tested the effects of emotional disclosure writing and peer helping writing in reducing psychological distress among Chinese international students. This study also examined whether rumination and ambivalence over emotion expression moderated the effects of emotional disclosure and peer helping writing. METHOD One hundred forty-four Chinese international students were randomly assigned to one of three conditions: emotional disclosure, peer helping, or neutral control writing. Participants completed two 20-min writing sessions and questionnaires at baseline, 2-month follow-up, and 4-month follow-up. RESULTS We found no significant differences across the three writing conditions in levels of psychological distress over time. However, rumination emerged as a significant moderator in both emotional disclosure and peer helping intervention conditions. High ruminators generally experienced significant reductions in depressive symptoms, whereas low ruminators experienced increased depressive symptoms. CONCLUSIONS These findings demonstrate that the benefits of writing interventions may vary as a function of rumination.
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Affiliation(s)
- William Tsai
- Department of Applied Psychology, New York University Steinhardt, New York, New York, USA
| | - Christina S Lee
- Department of Applied Psychology, New York University Steinhardt, New York, New York, USA
| | - Victoria Monte
- Department of Applied Psychology, New York University Steinhardt, New York, New York, USA
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Procaccia R, Segre G, Tamanza G, Manzoni GM. Benefits of Expressive Writing on Healthcare Workers' Psychological Adjustment During the COVID-19 Pandemic. Front Psychol 2021; 12:624176. [PMID: 33716890 PMCID: PMC7947213 DOI: 10.3389/fpsyg.2021.624176] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/26/2021] [Indexed: 01/24/2023] Open
Abstract
COVID-19 outbroke in Wuhan, China, in December 2019 and promptly became a pandemic worldwide, endangering health and life but also causing mild-to-severe psychological distress to lots of people, including healthcare workers (HCWs). Several studies have already showed a high prevalence of depression, anxiety, and post-traumatic symptoms in HCWs but less is known about the efficacy of psychological interventions for relieving their mental distress. The aims of this study were: (1) to evaluate the psychological adjustment of Italian HCWs during the COVID-19 pandemic; (2) to investigate the efficacy of an expressive writing (EW) intervention, based on Pennebaker's paradigmatic protocol, on their psychological adjustment; (3) to analyze if outcomes of EW vary in function of individual differences (age, gender, marital status, and baseline values of symptoms). Fifty-five HCWs were randomly assigned to one of two writing conditions: EW (n = 30) or neutral writing (NW; n = 25). Psychological adjustment (in terms of ptsd, depression and global psychopathology's symptoms, perceived social support, and resilience) was assessed before and after three writing sessions. Participants who received the EW intervention showed higher improvements in ptsd, depression, and global psychopathology symptoms. Improvements in EW group varied in function of age, gender, marital status, and baseline values: young, men, married participants and those who had higher baseline scores showed a higher reduction of psychological distress symptoms while women, single and those who had lower baseline value showed increased social support, and resilience. In conclusion, the EW intervention had positive effects which varied in function of individual differences on HCWs' psychological health.
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Affiliation(s)
| | - Giulia Segre
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - Giancarlo Tamanza
- Department of Psychology, Catholic University of Milan, Milan, Italy
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Behavioral Medicine Methods in Treatment of Somatic Conditions. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5076516. [PMID: 33204700 PMCID: PMC7655248 DOI: 10.1155/2020/5076516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/30/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
Background The aim of this article is to present a short review of noninvasive, nonpharmacological treatment methods used in somatic illnesses that fall under the umbrella of approach called behavioral medicine. Methods The narrative review method was applied in the study. Science paper databases, including PubMed, had been used to retrieve papers on therapeutic methods used in clinical setting that meet the broad criteria of behavioral medicine definition as stated in the Charter of International Behavioral Medicine Society Results Main groups of methods, disorders in which they are being employed and their effectiveness, have been identified. Conclusions Behavioral medicine is grouping treatment methods and interventions that hold large potential for clinical setting. Two groups of methods can be distinguished by the scrutiny and level of evidence gathered in their effectiveness assessment; for biofeedback, guided imagery, and hypnosis techniques, comprehensive evidence reports in the framework of U.S. Evidence Synthesis Program exist. Meditation techniques, disclosure therapies, and relaxation methods are less well assessed. Broader employment of behavioral medicine therapies in clinical setting is possible after addressing two major problems in the field, which are deficiencies in quality evidence of effectiveness for many of the methods and their insufficiencies in underlying therapeutic mechanism knowledge.
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Chu Q, Wu IHC, Tang M, Tsoh J, Lu Q. Temporal relationship of posttraumatic stress disorder symptom clusters during and after an expressive writing intervention for Chinese American breast cancer survivors. J Psychosom Res 2020; 135:110142. [PMID: 32485623 DOI: 10.1016/j.jpsychores.2020.110142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a significant condition and frequently observed among breast cancer survivors. Extant literature has demonstrated the effectiveness of expressive writing interventions in reducing PTSD among breast cancer survivors. However, little is known about how different PTSD symptom clusters influence each other over time during and after the expressive writing intervention among breast cancer survivors. We investigated how the three PTSD symptom clusters (reexperiencing, avoidance and hyperarousal) influence each other during and after an expressive writing intervention among Chinese American breast cancer survivors. METHODS Chinese American breast cancer survivors (n = 136) completed an expressive writing intervention. Their PTSD symptoms were assessed at baseline, 1-, 3-, and 6-month follow-ups. RESULTS Using cross-lagged panel analysis, the model with hyperarousal symptoms at each assessment wave predicting the subsequent severity of avoidance and reexperiencing symptoms indicated the best fit, χ2(52) = 65.422, p = .100; CFI = 0.990, RMSEA = 0.044, 95% CI [0.000, 0.074]. CONCLUSION The results suggest that hyperarousal symptoms predict the subsequent severity of reexperiencing and avoidance symptoms over time during and after the expressive writing intervention. The findings highlight the importance of early diagnosis, monitoring and treatment of hyperarousal symptoms in enhancing the efficacy of PTSD interventions and reducing the chronicity in PTSD among Chinese American breast cancer survivors. Clinical Trial Registration atClinicalTrials.gov: NCT02946619.
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Affiliation(s)
- Qiao Chu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ivan Haw Chong Wu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Moni Tang
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Janice Tsoh
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Psychology, University of Houston, Houston, TX, USA.
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Social Constraints and PTSD among Chinese American breast cancer survivors: not all kinds of social support provide relief. J Behav Med 2020; 44:29-37. [PMID: 32519299 DOI: 10.1007/s10865-020-00165-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
Research has demonstrated the association between social constraints and posttraumatic stress disorder (PTSD) symptoms among breast cancer survivors. Although perceived social support can buffer stress and improve emotional well-being, little is known about which type of social support is most effective in buffering the negative effects of social constraints among cancer survivors. We investigated the moderation of four types of social support (i.e., positive interaction, tangible support, emotional/informational support and affectionate support) on the association between social constraints and PTSD symptoms among Chinese American breast cancer survivors. One hundred and thirty-six Chinese American breast cancer survivors completed questionnaires that assessed social constraints, PTSD symptoms and perceived social support. Results of hierarchical regression analysis indicated that only support of positive interaction exerted a buffering effect, with social constraints associated with greater PTSD severity among survivors with low but not high levels of support of positive interaction. In contrast, high levels of tangible support potentiated the association between social constraints and PTSD symptoms. There were no moderating effects of emotional/informational support and affectionate support. These results demonstrated the roles of different types of social support in moderating the stress imposed by social constraints. Our findings highlight the importance of recognizing the potential cultural sensitivity of ethnic minorities in PTSD intervention and mental health services for cancer patients.
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Beh YS, Sajtos L, Cao JT. Complainers' resource investment and mobilization in digital environments using Conservation of Resources theory. JOURNAL OF SERVICE MANAGEMENT 2020. [DOI: 10.1108/josm-10-2018-0344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to consider whether consumers can recover from a service failure by utilizing internal and external energy resources that are available to them at the time of an online complaint. Based on the Conservation of Resources (COR) theory, this research conceptualizes the complainers' act of complaining through internal and external energy resources. By investing (direct utilization of resources) and mobilizing (utilizing resources to change the trajectory of a loss) these resources, this study aims to understand which resources (internal or external) and what strategies (investment or mobilization) are effective in the face of a resource loss.Design//methodology/approachStudy 1 aimed to test the impact of energy resources (motivation and affordance) on consumers' negative emotions and satisfaction with their complaints through an online panel survey. Study 2 was a between-subjects design experiment aimed to overcome the diversity of the circumstances around a service failure, complaint motivation and complaints that were captured in Study 1.FindingsThis study provides evidence of the negative and positive effects of internal and external energy resources, respectively, in altering the consumer's emotions and behavioral intentions. The findings of this study underline the role of affordances of features, specifically perceived conversationality of digital features, in improving consumers' relationship with the defaulting firm.Practical implicationsBased on the findings related to the perceived conversationality of digital features, managers are urged to explore the affordances of online features that consumers use for communications, in general, or for complaints, in particular.Originality/valueTo our understanding, this paper is the first study to employ COR theory as a conceptual background, and in turn, the first to conceptualize complaint motivations and online complaint features as internal and external resources, respectively. As such, this study is the first of its kind to examine complaint media systematically.
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Chu Q, Wu IHC, Lu Q. Expressive writing intervention for posttraumatic stress disorder among Chinese American breast cancer survivors: the moderating role of social constraints. Qual Life Res 2020; 29:891-899. [PMID: 31900761 DOI: 10.1007/s11136-019-02385-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Posttraumatic stress disorder (PTSD) is a significant condition among breast cancer survivors (BCSs). However, few intervention studies for cancer-related PTSD were conducted among Asian cancer survivors. We evaluated a culturally sensitive expressive writing intervention, which combined cognitive reappraisal and emotional disclosure, in reducing PTSD among Chinese American BCSs. We also tested social constraints (defined as social conditions when individuals feel misunderstood or alienated when they desire to disclose their thoughts and feelings) as a moderator. METHODS Chinese American BCSs (n = 136) were randomly assigned to three groups with assigned writing topics for 3 weeks: a self-regulation group, which wrote about the deepest feelings related to cancer in week 1, cognitive reappraisal about stress and coping in week 2, and benefit finding in week 3; an enhanced self-regulation group, with the same instructions, except weeks 1 and 2 were reversed; and a cancer-fact group, which wrote about cancer experiences objectively for 3 weeks. PTSD symptoms were measured at baseline and 1-, 3-, and 6-month follow-ups. Social constraints were measured at baseline. RESULTS Both the self-regulation and enhanced self-regulation groups showed reduced PTSD symptoms compared to the cancer-fact group. For reexperiencing and hyperarousal symptoms, expressive writing was more effective for BCSs who experienced high vs. low levels of social constraints; the opposite was found for avoidance symptoms. CONCLUSION Findings demonstrated the effectiveness of expressive writing intervention in reducing PTSD for this minority population, and that the moderating role of survivors' social network varies among different PTSD symptom clusters. ClinicalTrials.gov Identifier: NCT02946619.
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Affiliation(s)
- Qiao Chu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ivan H C Wu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA.
- Department of Psychology, University of Houston, Houston, TX, USA.
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The benefits of expressive writing among newly diagnosed mainland Chinese breast cancer patients. J Behav Med 2019; 43:468-478. [DOI: 10.1007/s10865-019-00127-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
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Lu Q, Gallagher MW, Loh A, Young L. Expressive Writing Intervention Improves Quality of Life Among Chinese-American Breast Cancer Survivors: A Randomized Controlled Trial. Ann Behav Med 2019; 52:952-962. [PMID: 30346497 DOI: 10.1093/abm/kax067] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Expressive writing interventions are shown to confer health benefits for Caucasian cancer survivors. However, few studies reported improved quality of life or studied ethnic minorities. Purpose The study evaluated whether a culturally sensitive expressive writing intervention improved quality of life. Methods Chinese-speaking breast cancer survivors (n = 136) in the USA were randomly assigned to one of three conditions to write three 30-min weekly essays: a cancer-fact condition to write about facts relevant to the cancer experience for three weeks; a self-regulation condition to write about deepest feelings at week 1, stress and coping at week 2, and finding benefits at week 3; or an enhanced self-regulation condition to write about stress and coping at week 1, deepest feelings at week 2, and finding benefits at week 3. Quality of life was assessed by Functional Assessment of Cancer Therapy at baseline, 1-, 3-, and 6-month follow-ups. Results Growth curve models showed that quality of life was increased in the sample from baseline to the 6-month follow-up. The enhanced self-regulation condition had a large and statistically significant effect (d = 0.90, 95% CI [0.02, 1.687]), and the self-regulation condition had a small effect (d = 0.22, 95% CI [-0.79, 1.07]) on quality of life improvement compared with the cancer-fact group. Conclusion Expressive writing is shown to be an effective intervention to improve quality of life for Chinese-American cancer survivors. Future efforts are warranted to disseminate and implement this low-dose and brief intervention in community and clinical settings. Clinical Trial Registration NCT02946619.
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Affiliation(s)
- Qian Lu
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Matthew W Gallagher
- Department of Psychology, University of Houston, Houston, TX, USA.,Texas Institute for Measurement, Evaluation and Statistics, University of Houston, Houston, TX, USA
| | - Alice Loh
- Herald Cancer Association, San Gabriel, CA, USA
| | - Lucy Young
- Herald Cancer Association, San Gabriel, CA, USA
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Caregiving burden and self-efficacy mediate the association between individual characteristics and depressive symptoms among husbands of Chinese breast cancer patients. Support Care Cancer 2019; 28:3125-3133. [DOI: 10.1007/s00520-019-05102-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
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Turner S, Moschella EA, Banyard VL. The Development and Psychometric Evaluation of the Reasons for Disclosing Sexual and Intimate Partner Violence Scale. VIOLENCE AND VICTIMS 2019; 34:569-591. [PMID: 31416968 DOI: 10.1891/0886-6708.vv-d-18-00118] [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: 06/10/2023]
Abstract
A wide body of research has studied what happens when survivors disclose interpersonal violence (Ullman, 2010; Ullman & Filipas, 2001). Less studied is why survivors disclose their experiences. Although research in other disciplines has created measures to assess the reasons for disclosing other concealable identities (Derlega, Winstead, Folk-Barron, & Petronio, 2000), the present study aimed to fill a gap in the existing literature by creating a measure to assess the reasons for disclosing sexual and intimate partner violence. The Reasons for Disclosing Sexual and Intimate Partner Violence Scale was created after interviewing survivors and receiving feedback on the measure from crisis center advocates and experts in the field (i.e., content validity). The psychometric properties (i.e., dimensionality and reliability) of the measure were tested with a sample of 274 adult female survivors of sexual and intimate partner violence. The results suggested that reasons for disclosing sexual and intimate partner violence can be broken down into seven factors (e.g., safety and justice, image validation), and that these reasons vary from other concealable identities.
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Affiliation(s)
- Sidney Turner
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | | | - Victoria L Banyard
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
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23
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Karibe H, Kato Y, Shimazu K, Okamoto A, Heima M. Gender differences in adolescents' perceptions toward dentists using the Japanese version of the dental beliefs survey: a cross-sectional survey. BMC Oral Health 2019; 19:144. [PMID: 31300056 PMCID: PMC6625028 DOI: 10.1186/s12903-019-0845-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background While adult women show greater dental anxiety than adult men, few studies have examined gender differences in adolescent perceptions of dentists. Therefore, this cross-sectional study aimed to evaluate the gender differences in adolescents’ perceptions toward dentists by using the Japanese version of the Dental Beliefs Survey (DBS) and the factor structure of the DBS. Methods We conducted surveys at schools, and 957 Japanese adolescents (403 girls and 554 boys, aged between 13 and 15 years) participated in this study. To assess their confidence in dentists, participants were asked to complete the self-reported, 15-item Japanese version of the DBS. We performed a Welch’s t-test and a one-way analysis of variance to assess differences in DBS scores by gender and age. Factor analysis (principal components, varimax rotation) was used to assess the scale’s factor structure. Results A significant gender difference was observed in the DBS scores (P = 0.018), suggesting that boys exhibit greater negative perceptions toward the behavior of dentists than girls. However, there was no significant difference found among ages. The factor analysis yielded two results: Factor 1, “trust” (seven items); and Factor 2, “lack of control” (five items). Notably, the factor structure differed according to gender. As such, by including only factors with eigenvalues above 1.0, the DBS for girls comprised “trust” (seven items) and “communication” (three items), while that for boys comprised “lack of control” (six items) and “belittlement” (six items). Conclusions This study identified two factors of differing strengths pertaining to the confidence of Japanese adolescents in dentists. Gender differences in perceptions toward dentists were observed. Accounting for these differences may improve the effectiveness of strategies to lower dental anxiety and foster positive dental beliefs in young patients.
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Affiliation(s)
- Hiroyuki Karibe
- Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi Chiyoda, Tokyo, 102-8159, Japan.
| | - Yuichi Kato
- Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi Chiyoda, Tokyo, 102-8159, Japan
| | - Kisaki Shimazu
- Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi Chiyoda, Tokyo, 102-8159, Japan
| | - Ayuko Okamoto
- Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi Chiyoda, Tokyo, 102-8159, Japan
| | - Masahiro Heima
- Department of Pediatric Dentistry, School of Dental Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4905, USA
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Acculturation Moderates the Effects of Expressive Writing on Post-Traumatic Stress Symptoms Among Chinese American Breast Cancer Survivors. Int J Behav Med 2019; 26:185-194. [PMID: 30656609 DOI: 10.1007/s12529-019-09769-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Previous research indicated that the benefits of expressive writing on cancer patients' physical and psychological well-being may vary across cultures. However, it remains unknown whether the within-ethnicity cultural orientation would also moderate the efficacy of expressive writing. Immigrants are a special population who differ widely in extent of endorsing the home culture and the host culture. We examined the role of acculturation in moderating the effect of expressive writing among Chinese American breast cancer survivors in reducing different post-traumatic stress disorder (PTSD) symptom clusters: re-experiencing, avoidance, and arousal. METHOD Ninety-six Chinese American breast cancer survivors were randomly assigned to three groups to write about cancer-related topics: a self-regulation group to write about deepest feelings, stress coping, and finding benefits; an emotional disclosure group to write about deepest feelings; and a cancer-fact group to write about cancer experience objectively. The only examined moderator, acculturation, was assessed at baseline. PTSD symptoms were assessed at baseline and 1-, 3-, and 6-month follow-ups. RESULTS Acculturation moderated the effect of expressive writing at 3- and 6-month follow-ups. Among participants with low acculturation, PTSD symptoms were less severe in the self-regulation and cancer-fact groups compared with the emotional disclosure group; in contrast, no group differences in PTSD were found among highly acculturated participants. CONCLUSIONS Our findings highlight the important role of sub-ethnic cultural orientation in the efficacy of psychosocial interventions targeting immigrant populations. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03546673.
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Ji L, Tsai W, Sun X, Lu Q, Wang H, Wang L, Lu G. The detrimental effects of ambivalence over emotional expression on well‐being among Mainland Chinese breast cancer patients: Mediating role of perceived social support. Psychooncology 2019; 28:1142-1148. [DOI: 10.1002/pon.5069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Li‐li Ji
- Department of Medical NursingWeifang Medical University Weifang
| | - William Tsai
- Department of Applied PsychologyNew York University New York City New York
| | - Xiang‐lian Sun
- Department of Breast SurgeryWeifang People's Hospital Weifang
| | - Qian Lu
- Department of PsychologyUniversity of Houston Houston Texas
- Department of Health Disparities ResearchUniversity of Texas MD Anderson Cancer Center Houston Texas
| | - Hui‐dong Wang
- Department of Breast SurgeryWeifang People's Hospital Weifang
| | - Li‐juan Wang
- Department of Breast SurgeryWeifang People's Hospital Weifang
| | - Guo‐hua Lu
- Department of PsychologyWeifang Medical University Weifang
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26
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Yeung NCY, Zhang Y, Ji L, Lu G, Lu Q. Correlates of sexual quality of life among husbands of Chinese breast cancer survivors. Eur J Oncol Nurs 2019; 40:63-70. [PMID: 31229208 DOI: 10.1016/j.ejon.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/27/2019] [Accepted: 03/31/2019] [Indexed: 11/15/2022]
Abstract
PURPOSE Western studies found that sexual quality of life (QoL) among husbands of breast cancer survivors was associated with their stress and coping processes. However, little is known about how breast cancer caregiving might be associated with those husbands' sexual QoL in the Chinese cultural context. Guided by the Stress and Coping model, we examined the psychosocial correlates of sexual QoL among husbands of Chinese breast cancer survivors. METHOD Husbands of Chinese breast cancer survivors (N = 176) recruited from two hospitals in Weifang, China completed a cross-sectional survey. Their individual characteristics, caregiving-related stressors, cognitive appraisals, coping resources and strategies, and sexual QoL were measured. RESULTS After controlling for covariates, hierarchical regression results showed that lower caregiving burden (β = -0.34, p < .001), higher marital satisfaction (β = 0.20, p < .001), and lower harm/threat appraisals (β from -0.22 to -0.20, p < .001) were associated with better sexual QoL. Moreover, ambivalence over emotional expression (AEE; inner conflict concerning the desire to express emotions yet failing to do so) was found to moderate between protective buffering and sexual QoL (β = 0.20, p < .01), such that the negative association between protective buffering and sexual QoL was only significant among those with higher AEE (β = -0.38, p < .003). CONCLUSIONS Both the stress and coping variables and their interactions with individual characteristics could be important determinants of those husbands' sexual QoL. Our findings implied that reducing husbands' caregiving burden, increasing their marital satisfaction, helping them reevaluate the negative impact of breast cancer, and reducing barriers for expressing emotions and concerns may increase their sexual well-being.
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Affiliation(s)
- Nelson C Y Yeung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, PR China
| | - Yiwei Zhang
- Department of Medical Nursing, Weifang Medical University, China
| | - Lili Ji
- Department of Medical Nursing, Weifang Medical University, China
| | - Guohua Lu
- Department of Medical Nursing, Weifang Medical University, China.
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, United States.
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27
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Shahane AD, Denny BT. Predicting emotional health indicators from linguistic evidence of psychological distancing. Stress Health 2019; 35:200-210. [PMID: 30623579 DOI: 10.1002/smi.2855] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 12/09/2018] [Accepted: 12/14/2018] [Indexed: 11/11/2022]
Abstract
Psychological distancing, a form of cognitive reappraisal, involves construal of emotionally valenced stimuli in an objective manner, or with perceived spatial and temporal distance. Prior work suggests that in appropriate contexts, reappraisal broadly, and distancing specifically, is related to adaptive mental and physical health outcomes. Additionally, recent research suggests that shifting language to be more distant (i.e., linguistic distancing [LD]) can have adaptive emotion regulatory effects. The present study addressed whether LD is also associated with adaptive health indicators. Participants transcribed their thoughts while viewing negative or neutral stimuli in one of three ways: (a) by implementing objective language, (b) by implementing spatially and/or temporally far away language, or (c) by responding naturally. Across psychological distancing groups, LD was associated with lower negative affectivity (lower perceived stress and depression symptoms), better general well-being (better emotional well-being and energy and vitality), and better emotion regulation (ER; greater reappraisal frequency and fewer difficulties in implementing ER). Participants who used more LD in the objective group had lower negative affectivity, better general well-being, and better ER, and those in the far group had better ER. The results reveal linguistic mechanisms underlying ER and its relationship to health indicators, suggesting future examination of LD interventions.
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Affiliation(s)
- Anoushka D Shahane
- Department of Psychological Sciences, Rice University, Houston, Texas, USA
| | - Bryan T Denny
- Department of Psychological Sciences, Rice University, Houston, Texas, USA
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Tsai W, Wu IHC, Lu Q. Acculturation and quality of life among Chinese American breast cancer survivors: The mediating role of self-stigma, ambivalence over emotion expression, and intrusive thoughts. Psychooncology 2019; 28:1063-1070. [PMID: 30838727 DOI: 10.1002/pon.5053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/22/2019] [Accepted: 02/28/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Highly acculturated Chinese American breast cancer survivors have greater access to health care providers, are English language proficient, and have more knowledge about the health care system. However, less is known about the potential psychosocial factors that may account for the health benefits of acculturation. As such, the current study seeks to understand how mainstream acculturation is associated with higher quality of life by investigating self-stigma, ambivalence over emotion expression (AEE), and intrusive thoughts, as serial mediators among Chinese breast cancer survivors. METHODS One hundred twelve Chinese American breast cancer survivors completed a self-reported questionnaire with these trait variables. RESULTS We found support for a serial multiple mediation hypothesis in which mainstream acculturation was indirectly associated with quality of life through self-stigma, AEE, and intrusive thoughts. Specifically, mainstream acculturation was associated with lower self-stigma, which, in turn, was associated with lower AEE and intrusive thoughts and subsequently resulted in lower quality of life among Chinese American breast cancer survivors. CONCLUSIONS The findings suggest that psychosocial factors are important mechanisms through which acculturation is associated with quality of life among Chinese American breast cancer survivors. As Chinese immigrants acculturate to mainstream American culture, they may benefit from the reduced public stigma toward breast cancer and incorporate new post-immigration knowledge about cancer that protects them from high levels of self-stigma. This, in turn, may lead Chinese American breast cancer survivors to experience lower AEE and intrusive thoughts and subsequently experience higher quality of life.
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Affiliation(s)
- William Tsai
- Department of Applied Psychology, New York University, New York, New York
| | - Ivan H C Wu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas
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Michailidis E, Cropley M. Testing the benefits of expressive writing for workplace embitterment: a randomized control trial. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2019. [DOI: 10.1080/1359432x.2019.1580694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Mark Cropley
- School of Psychology, University of Surrey, Guildford, UK
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Tsai W, Lu Q. Perceived Social Support Mediates the Longitudinal Relations between Ambivalence over Emotional Expression and Quality of Life among Chinese American Breast Cancer Survivors. Int J Behav Med 2019; 25:368-373. [PMID: 29238936 DOI: 10.1007/s12529-017-9705-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The present study examined perceived social support as a mediator of the longitudinal link between ambivalence over emotional expression (AEE) and quality of life among a sample of Chinese breast cancer survivors. METHODS Ninety-six Chinese breast cancer survivors recruited from Southern California completed four surveys in total: (1) a baseline survey (T1), 1-month follow-up (T2), 3-month follow-up (T3), and 6-month follow-up (T4). Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), and the Medical Outcomes Study Social Support Scale (MOS-SSS). RESULTS Higher T1 AEE was associated with lower T1 social support (B = -0.01, SE = 0.004, p < 0.01) which in turn was associated with lower quality of life at T2 (B = 2.98, SE = 0.64, p < 0.01), T3 (B = 2.14, SE = 0.54, p < 0.01), and T4 (B = 2.08, SE = 0.68, p < 0.01). CONCLUSIONS These results suggest that the harmful effect of AEE on quality of life is explained by reduced social support. Given the detrimental effects of AEE on social support and quality of life, future research on interventions that facilitate emotional disclosure is needed. Implications for the effects of Chinese culture on AEE are discussed.
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Affiliation(s)
- William Tsai
- Department of Psychology, California State University San Marcos, San Marcos, CA, USA
| | - Qian Lu
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, USA.
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Powers JP, LaBar KS. Regulating emotion through distancing: A taxonomy, neurocognitive model, and supporting meta-analysis. Neurosci Biobehav Rev 2018; 96:155-173. [PMID: 30502352 DOI: 10.1016/j.neubiorev.2018.04.023] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/13/2018] [Accepted: 04/29/2018] [Indexed: 01/09/2023]
Abstract
Distancing is a type of emotion regulation that involves simulating a new perspective to alter the psychological distance and emotional impact of a stimulus. The effectiveness and versatility of distancing relative to other types of emotion regulation make it a promising tool for clinical applications. However, the neurocognitive mechanisms of this tactic are unclear, and inconsistencies in terminology and methods across studies make it difficult to synthesize the literature. To promote more effective research, we propose a taxonomy of distancing within the broader context of emotion regulation strategies; review the effects of this tactic; and offer a preliminary neurocognitive model describing key cognitive processes and their neural bases. Our model emphasizes three components-self-projection, affective self-reflection, and cognitive control. Additionally, we present results from a supporting meta-analysis of neuroimaging studies of distancing. These efforts are presented within the overarching goals of supporting effective applications of distancing in laboratory, clinical, and other real-world contexts, and advancing understanding of the relevant high-level cognitive functions in the brain.
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Affiliation(s)
- John P Powers
- Duke University, Department of Psychology & Neuroscience, Center for Cognitive Neuroscience, Box 90999, Durham, NC, 27708-0999, United States.
| | - Kevin S LaBar
- Duke University, Department of Psychology & Neuroscience, Center for Cognitive Neuroscience, Box 90999, Durham, NC, 27708-0999, United States.
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Kane HS, Wiley JF, Dunkel Schetter C, Robles TF. The effects of interpersonal emotional expression, partner responsiveness, and emotional approach coping on stress responses. ACTA ACUST UNITED AC 2018; 19:1315-1328. [PMID: 30265076 DOI: 10.1037/emo0000487] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
[Correction Notice: An Erratum for this article was reported online in Emotion on Sep 5 2019 (see record 2019-52812-001). In the article, two text call outs for figures are incorrect. At the end of the "Negative emotional responses" section under the "Psychological Stress Responses" heading, "(see Figure 7)" should have been deleted. Under the "Negative task-related ruminative thoughts" heading in that same section, "(see Figure 5)" in the first paragraph should be "(see Figure 7)."] Expressing emotions is a common strategy for coping with stress. Yet, little is known about the effects of using this strategy in close relationships, or when and for whom emotional expression is effective. This study examined romantic partner responsiveness and the dispositional tendency to use emotional approach coping (EAC; the processing and expression of emotions) as moderators of the effects of experimentally manipulated emotional expression on stress responses to a laboratory stressor. We brought couples (N = 145) to the lab and randomly assigned 1 partner (the participant) to perform a stressful task. We manipulated whether participants expressed their feelings about the task to their partner (expression vs. no-expression), and whether participants received supportive messages from their partners (as an indicator of partner responsiveness; support vs. no-support). We examined physiological stress responses (cortisol and salivary alpha-amylase [sAA]), negative emotional stress responses (anxiety and self-conscious emotions), and post-task ruminative thoughts. Participants high in EAC showed larger sAA and cortisol responses and reported more negative post-task ruminative thoughts after emotionally expressing to their partners, but partner support mitigated the effect on cortisol. Participants low in EAC showed smaller cortisol responses and reported less negative emotional responses and fewer negative post-task ruminative thoughts after emotionally expressing to their partners. Receiving partner support reduced negative emotional responses for people high in EAC, but increased negative emotional responses for those low in EAC. These results may help explain when and for whom emotional expression is an effective means of coping in the immediate context of a stressor. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Emotional processing in an expressive writing task on trauma. Complement Ther Clin Pract 2018; 32:116-122. [DOI: 10.1016/j.ctcp.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 01/04/2023]
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Nakagawa T, Yamane S. Emotional word use and longevity among Japanese business leaders. JOURNAL OF RESEARCH IN PERSONALITY 2018. [DOI: 10.1016/j.jrp.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ambivalence over emotional expression and physical functioning and limitations: mediating and moderating effects of PTSD symptoms and acculturation among Chinese breast cancer survivors. Support Care Cancer 2018; 27:311-319. [DOI: 10.1007/s00520-018-4329-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
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Lu Q, Dong L, Wu IHC, You J, Huang J, Hu Y. The impact of an expressive writing intervention on quality of life among Chinese breast cancer patients undergoing chemotherapy. Support Care Cancer 2018; 27:165-173. [PMID: 29915994 DOI: 10.1007/s00520-018-4308-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/06/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Expressive writing interventions are shown to confer physical and psychological benefits for Caucasian cancer survivors. This study evaluated the health benefits of an expressive writing intervention among breast cancer patients in mainland China. METHODS Stage I-III Chinese breast cancer survivors undergoing chemotherapy were recruited in Shanghai, China. They (n = 90) were randomly assigned to one of three conditions: a positive thinking group (PTC) to write about the positive aspects of their cancer experience; a self-regulation condition (SRC) to write about their stress and coping efforts, deepest feelings, and positive aspects of their cancer experience; or a cancer-fact group (CFC) to write about facts relevant to their cancer experience. All groups wrote for 30 min every week for 4 weeks. Quality of life (QOL) was assessed using the FACT-B at baseline and 1- and 2-month follow-ups. Linear mixed effects models were used to test the hypotheses that the SRC and PTC would improve QOL compared to the CFC. RESULTS QOL improved overtime in the whole sample. Contrary to hypotheses, the CFC had increased QOL compared with the SRC from baseline to both the 1- and 2-month follow-ups (ΔQOL = 9.31, p = 0.01, d = 0.44; ΔQOL = 9.45, p = 0.025, d = 0.49). The PTC did not differ from cancer-fact writing but had increased QOL compared with the SRC from baseline to both the 1- and 2-month follow-ups (ΔQOL = 7.44, p = 0.04, d = 0.35; ΔQOL = 11.72, p = 0.06, d = 0.61). CONCLUSION Interventions through expressive writing about positive experience and cancer facts are feasible and can benefit Chinese cancer patients undergoing chemotherapy.
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Affiliation(s)
- Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, USA. .,Department of Psychology, University of Houston, Houston, TX, USA.
| | - Lu Dong
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ivan H C Wu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jin You
- Wuhan University, Wuhan, China
| | - Jialing Huang
- Breast Cancer Unit, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China.
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Lu Q, Tsai W, Chu Q, Xie J. Is expressive suppression harmful for Chinese American breast cancer survivors? J Psychosom Res 2018; 109:51-56. [PMID: 29773152 PMCID: PMC8054769 DOI: 10.1016/j.jpsychores.2018.03.171] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/31/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
Emotion regulation strategies are important for cancer survivors' adjustment. Expressive suppression, defined as the active effort of inhibiting the expressive component of an emotional response, has been found to be a maladaptive emotion regulation strategy. These studies, however, have been limited to cross-sectional designs and primarily European American samples. Chinese culture encourages emotion suppression to preserve interpersonal harmony and therefore it may be important to test these emotion regulation processes with this population. This study aimed to examine the longitudinal effects of expressive suppression, ambivalence over emotional expression (i.e., inner conflict over emotional expression), and cognitive reappraisal on quality of life among Chinese American breast cancer survivors. 103 participants completed a questionnaire assessing expressive suppression, ambivalence over emotional expression, cognitive reappraisal, and quality of life at baseline and a questionnaire assessing quality of life eight weeks later. Consistent with our hypotheses, baseline ambivalence over emotional expression was associated with lower follow-up quality of life above and beyond the effect of expressive suppression. Furthermore, cognitive reappraisal moderated the relations between expressive suppression and follow-up quality of life, such that expressive suppression may be less detrimental for Chinese American breast cancer survivors who are able to regulate their emotions using cognitive reappraisal. Implications for informing interventions for Chinese American breast cancer survivors are discussed.
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Affiliation(s)
- Qian Lu
- Department of Psychology, University of Houston, Houston, USA; Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, USA.
| | - William Tsai
- Department of Psychology, California State University, San Marcos, USA
| | - Qiao Chu
- Department of Psychology, University of Houston, Houston, USA
| | - Jing Xie
- Department of Psychology, University of Houston, Houston, USA
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Gallagher MW, Long LJ, Tsai W, Stanton AL, Lu Q. The unexpected impact of expressive writing on posttraumatic stress and growth in Chinese American breast cancer survivors. J Clin Psychol 2018; 74:1673-1686. [PMID: 29727480 DOI: 10.1002/jclp.22636] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/13/2018] [Accepted: 04/10/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study examined the impact of expressive writing on reducing posttraumatic stress disorder symptoms (PTSS) and facilitating posttraumatic growth (PTG) in Chinese American breast cancer survivors. METHOD Ninety-six women who had completed primary treatments for breast cancer were randomly assigned to a cancer experience facts condition, an emotional disclosure condition, or a self-regulation condition and wrote on three occasions over 3 weeks. Participants completed outcome assessments at baseline and 1, 3, and 6 months after the last writing session. RESULTS Surprisingly, results indicated that there was generally a small increase in PTSS (ESsg = .16) and a small decrease in PTG (ESsg = -.16) from baseline to the 6-month follow-up. Effect size comparisons and latent growth curve models also indicated that the cancer facts condition was generally associated with superior outcomes for both PTSS and PTG. CONCLUSIONS These findings speak to the importance of examining whether interventions are equally efficacious in different cultures.
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Affiliation(s)
| | | | | | | | - Qian Lu
- University of Houston, University of Texas MD Anderson Cancer Center
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Tsai W, Lu Q. Culture, emotion suppression and disclosure, and health. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2018. [DOI: 10.1111/spc3.12373] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shen L, Yang L, Zhang J, Zhang M. Benefits of expressive writing in reducing test anxiety: A randomized controlled trial in Chinese samples. PLoS One 2018; 13:e0191779. [PMID: 29401473 PMCID: PMC5798770 DOI: 10.1371/journal.pone.0191779] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 01/11/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose To explore the effect of expressive writing of positive emotions on test anxiety among senior-high-school students. Methods The Test Anxiety Scale (TAS) was used to assess the anxiety level of 200 senior-high-school students. Seventy-five students with high anxiety were recruited and divided randomly into experimental and control groups. Each day for 30 days, the experimental group engaged in 20 minutes of expressive writing of positive emotions, while the control group was asked to merely write down their daily events. A second test was given after the month-long experiment to analyze whether there had been a reduction in anxiety among the sample. Quantitative data was obtained from TAS scores. The NVivo10.0 software program was used to examine the frequency of particular word categories used in participants’ writing manuscripts. Results Senior-high-school students indicated moderate to high test anxiety. There was a significant difference in post-test results (P < 0.001), with the experimental group scoring obviously lower than the control group. The interaction effect of group and gender in the post-test results was non-significant (P > 0.05). Students’ writing manuscripts were mainly encoded on five code categories: cause, anxiety manifestation, positive emotion, insight and evaluation. There was a negative relation between positive emotion, insight codes and test anxiety. There were significant differences in the positive emotion, anxiety manifestation, and insight code categories between the first 10 days’ manuscripts and the last 10 days’ ones. Conclusions Long-term expressive writing of positive emotions appears to help reduce test anxiety by using insight and positive emotion words for Chinese students. Efficient and effective intervention programs to ease test anxiety can be designed based on this study.
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Affiliation(s)
- Lujun Shen
- School of Psychology, Xinxiang Medical University, Xinxiang City, Henan Province, P. R. China
- * E-mail:
| | - Lei Yang
- School of Psychology, Xinxiang Medical University, Xinxiang City, Henan Province, P. R. China
| | - Jing Zhang
- School of Psychology, Xinxiang Medical University, Xinxiang City, Henan Province, P. R. China
| | - Meng Zhang
- School of Psychology, Xinxiang Medical University, Xinxiang City, Henan Province, P. R. China
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Lee M, Song Y, Zhu L, Ma GX. Coping Strategies and Benefit-finding in the Relationship between Non-disclosure and Depressive Symptoms among Breast Cancer Survivors in China. Am J Health Behav 2017; 41:368-377. [PMID: 28601096 DOI: 10.5993/ajhb.41.4.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Open communication about cancer diagnosis and relevant stress is frequently avoided among breast cancer survivors in China. Non-disclosure behavior may lead to negative psychological consequences. We aimed to examine the relationship between non-disclosure and depressive symptoms, and the role of coping strategies and benefit-finding in that relationship among Chinese breast cancer survivors. METHODS Using convenience sampling, we recruited 148 women in an early survivorship phase (up to 6 years post-treatment) in Nanjing, China. Participants were asked to complete a set of questionnaires in Chinese language, regarding sociodemographic characteristics, depressive symptoms, disclosure views, coping strategies, and benefit-finding. RESULTS A higher level of non-disclosure was associated with more depressive symptoms. This relationship was mediated by self-blame and moderated by benefit-finding. Specifically, non-disclosure was associated with depressive symptoms through self-blame. The impact of non-disclosure was minimized among the women with a higher level of benefit-finding. CONCLUSION Unexpressed cancer-related concern may increase self-blame, which leads to emotional distress among Chinese breast cancer survivors. Practicing benefit-finding may reduce the negative impact of non-disclosure. As a culturally appropriate way of disclosure, written expression may be beneficial to Chinese breast cancer patients.
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Affiliation(s)
- Minsun Lee
- Center for Asian Health, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Yuan Song
- Nanjing Cancer Survivor Association, Nanjing, China
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,
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Tsai W, Lu Q. Acculturation matters in the relation between ambivalence over emotional expressions and well-being among Chinese American breast cancer survivors. Qual Life Res 2017; 26:2755-2762. [PMID: 28597110 DOI: 10.1007/s11136-017-1618-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Ambivalence over emotional expression (AEE) is the inner conflict of desiring emotion expression and fearing consequence of emotion expression. Few studies to date have examined the effects of AEE within an ethnic group that prioritizes emotional self-control. The present study examined the associations between AEE and well-being (viz., quality of life and depressive symptoms) as a function of acculturation among a sample of Chinese American breast cancer survivors. METHODS Ninety-six Chinese breast cancer survivors (M age = 54.64 years old, SD = 7.98) were recruited from Southern California. Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-Breast (FACT-B), and the Center for Epidemiologic Studies Depression Scale-Short Form (CESD-10). RESULTS Acculturation was a statistically significant moderator of the relations between AEE and depressive symptoms, and a statistically marginally significant moderator of the relations between AEE and quality of life. Simple slopes revealed that AEE was negatively associated with quality of life (B = -.45, p < .001) and depressive symptoms (B = .20, p < .001) for women with high acculturation, but not associated for women with low acculturation (Bs = -.15 and .04, ps > .05, for quality of life and depressive symptoms, respectively). CONCLUSIONS These results suggest that less acculturated Chinese breast cancer survivors are protected by Chinese cultural values of emotional self-control and restraint, and thus do not experience the detrimental effects of AEE on their depressive symptoms and quality of life. Implications are discussed.
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Affiliation(s)
- William Tsai
- Department of Psychology, California State University, San Marcos, USA.
| | - Qian Lu
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, USA.
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Ambivalence over emotional expression, intrusive thoughts, and posttraumatic stress symptoms among Chinese American breast cancer survivors. Support Care Cancer 2017; 25:3281-3287. [DOI: 10.1007/s00520-017-3744-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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Sultan N. Embodied Self-Care: Enhancing Awareness and Acceptance Through Mindfulness-Oriented Expressive Writing Self-Disclosure. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2017. [DOI: 10.1080/15401383.2017.1286277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Convince Me: The Effects of Persuasive Writing on Event Centrality. APPLIED COGNITIVE PSYCHOLOGY 2016. [DOI: 10.1002/acp.3296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Match between culture and social support: Acculturation moderates the relationship between social support and well-being of Chinese American breast cancer survivors. Qual Life Res 2016; 26:73-84. [DOI: 10.1007/s11136-016-1362-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/27/2022]
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Seeley SH, Yanez B, Stanton AL, Hoyt MA. An emotional processing writing intervention and heart rate variability: the role of emotional approach. Cogn Emot 2016; 31:988-994. [PMID: 27082841 DOI: 10.1080/02699931.2016.1170667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Expressing and understanding one's own emotional responses to negative events, particularly those that challenge the attainment of important life goals, is thought to confer physiological benefit. Individual preferences and/or abilities in approaching emotions might condition the efficacy of interventions designed to encourage written emotional processing (EP). This study examines the physiological impact (as indexed by heart rate variability (HRV)) of an emotional processing writing (EPW) task as well as the moderating influence of a dispositional preference for coping through emotional approach (EP and emotional expression (EE)), in response to a laboratory stress task designed to challenge an important life goal. Participants (n = 98) were randomly assigned to either EPW or fact control writing (FCW) following the stress task. Regression analyses revealed a significant dispositional EP by condition interaction, such that high EP participants in the EPW condition demonstrated higher HRV after writing compared to low EP participants. No significant main effects of condition or EE coping were observed. These findings suggest that EPW interventions may be best suited for those with preference or ability to process emotions related to a stressor or might require adaptation for those who less often cope through emotional approach.
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Affiliation(s)
- Saren H Seeley
- a Department of Psychology , University of Arizona , Tucson , AZ , USA
| | - Betina Yanez
- b Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Annette L Stanton
- c Department of Psychology , University of California , Los Angeles , CA , USA
| | - Michael A Hoyt
- d Department of Psychology , Hunter College and the Graduate Center, City University of New York , New York , NY , USA
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Banyard V, Hamby S, de St. Aubin E, Grych J. Values Narratives for Personal Growth: Formative Evaluation of the Laws of Life Essay Program. JOURNAL OF HUMANISTIC PSYCHOLOGY 2015. [DOI: 10.1177/0022167815618494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence that even very brief writing exercises can change the way people see themselves and promote more positive mental and physical health has led to increased interest in their use in school settings and elsewhere. To date, however, research designs rely heavily on samples of college students and experimental studies of writing tasks carried out in the lab. There has been less investigation of the potential impact of more naturally occurring expressive writing exercises that exist in places like schools and that focus on adolescents. The current study was a process evaluation of the Laws of Life Essay, a values-based narrative program that was part of participants’ secondary school experience. It examined participants’ views of the impact of the program on their personal growth and, given the age range of participants, allowed for process evaluation of its perceived short- and long-term effects. Qualitative, semistructured interviews with 55 adolescent and adult participants were collected. Themes in participants’ responses included the importance of reflection and reappraisal of values, adversity, and relationships. Participants also discussed the importance of an audience for their writing, a novel finding that suggests one possible way to increase the impact of other narrative programs. Participants described variability in their engagement with expressive writing. This is one of the few studies that examined participants’ own views of the value of expressive writing and their responses suggest directions for future research and implications for designing expressive writing tasks to support social emotional learning and character education in schools and promote well-being at key developmental moments.
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Affiliation(s)
| | - Sherry Hamby
- Sewanee University of the South, Sewanee, TN, USA
| | | | - John Grych
- Marquette University, Milwaukee, WI, USA
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Tsai W, Chiang JJ, Lau AS. The Effects of Self-Enhancement and Self-Improvement on Recovery From Stress Differ Across Cultural Groups. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2015. [DOI: 10.1177/1948550615598380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extant research shows that individuals can reflect either adaptively or maladaptively over negative experiences. However, few studies have examined how culture influences this process. We examined the effects of self-enhancement and self-improvement reflection on emotional and physiological recovery from a laboratory social stressor among 56 Asian Americans (interdependent cultural group) and 58 European Americans (independent cultural group). The extent to which people gained emotional and physiological benefits from self-reflection depended on whether the self-reflection processes were congruent with individuals’ heritage cultural backgrounds. When there was a cultural match, participants showed improved emotional recovery, quicker return to baseline levels of cortisol, and greater persistence following the stressor. These findings provide evidence suggesting culturally distinct processes through which individuals recover from negative experiences.
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Affiliation(s)
| | | | - Anna S. Lau
- University of California, Los Angeles, CA, USA
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