The benefits and risks of telling and listening to stories of difficulty over time: experimentally testing the expressive writing paradigm in the context of interpersonal communication between friends

Feasibility, acceptability, and outcomes of a pilot intervention facilitating communication about family building between patients with inherited cancer risk and their partners

Objective

This study reports the feasibility, acceptability, and outcomes of a longitudinal, communication pilot intervention for patients with inherited cancer risk and their partners.

Methods

Couples were recruited through social media and snowball sampling. At Time 1 and 2, 15 couples completed a structured discussion task about family building concerns and decisions, followed by an online post-discussion questionnaire and dyadic interview to provide feedback about the experience. Interview data were analyzed to assess outcomes using applied thematic analysis.

Results

Participants reported the intervention created an opportunity for honest disclosure of family building goals and concerns. Participants also stated the structured nature of the discussion task was useful and did not cause additional stress. The intervention ultimately aided at-risk patients and their partners to realize their concordant concerns, discover/confront discordant concerns, and mutually agree upon next steps.

Conclusions

This pilot intervention is feasible and acceptable. Furthermore, it offers a framework to facilitate effective communication about family building between patients with inherited cancer risk and their partners.

Innovation

This intervention is the first conversational tool designed for at-risk patients and their partners.

Ease of Mind or Ties That Bind? Costs and Benefits of Disclosing Daily Hassles in Partnerships

People often tell others about recent daily hassles. Such social sharing of emotion is often assumed to support affect repair, but empirical evidence points to the contrary. We tested the notion that social sharing primarily serves relationship closeness, rather than immediate affect repair. Using dyadic experience sampling with N = 100 couples, we captured social sharing in everyday contexts and assessed socioemotional implications for speakers and listeners. Across M = 87 individual measurement occasions, both partners reported potential social-sharing episodes following daily hassles and rated their momentary negative affect and relationship closeness. Global evaluations of relationship closeness were assessed at baseline and 2.5 years later. Social sharing involved both affective benefits and costs, but it predicted momentary and long-term increases in partners’ relationship closeness. These results suggest that sharing bad news in relationships may not primarily serve immediate affect–repair functions. Rather, it may be a catalyst for creating and nourishing relationship closeness.

Impact of Relationship and Communication Variables on Ambulatory Blood Pressure in Advanced Cancer Caregivers

BACKGROUND

Cancer impacts both patients and their family caregivers. Evidence suggests that caregiving stress, including the strain of taking on a new role, can elevate the risk of numerous health conditions, including high blood pressure (BP). However, the caregiver's psychosocial experiences, including their interpersonal relationship with the patient, may buffer some of the negative physiological consequences of caregiving.

PURPOSE

To examine the influence of psychosocial contextual variables on caregiver ambulatory BP.

METHODS

Participants were 81 spouse-caregivers of patients with advanced gastrointestinal or thoracic cancer. For an entire day at home with the patient, caregivers wore an ambulatory BP monitor that took readings at random intervals. Immediately after each BP reading, caregivers reported on physical circumstances (e.g., posture, activity) and psychosocial experiences since the last BP measurement, including affect, caregiver and patient disclosure, and role perceptions (i.e., feeling more like a spouse vs. caregiver). Multilevel modeling was used to examine concurrent and lagged effects of psychosocial variables on systolic and diastolic BP, controlling for momentary posture, activity, negative affect, and time.

RESULTS

Feeling more like a caregiver (vs. spouse) was associated with lower systolic BP at the same time point. Patient disclosure to the caregiver since the previous BP reading was associated with higher diastolic BP. No lagged effects were statistically significant.

CONCLUSIONS

Caregivers' psychosocial experiences can have immediate physiological effects. Future research should examine possible cognitive and behavioral mechanisms of these effects, as well as longer-term effects of caregiver role perceptions and patient disclosure on caregiver psychological and physical health.

The My Life, My Story Program: Sustained Impact of Veterans' Personal Narratives on Healthcare Providers 5 Years After Implementation

Patient-centered care promotes positive patient, staff, and organizational outcomes. Communication is one critical element of patient-centered care. Establishing a patient-provider relationship in which a patient feels comfortable sharing their goals, preferences, and values is important to support patient-centered care and positive health outcomes. The My Life, My Story (MLMS) program was developed in 2013 to elicit and share Veterans' life stories with their healthcare providers. Life stories become part of the Veteran's chart so providers can access, read, and utilize as appropriate. To evaluate the program's sustained value and impact 5 years after implementation, healthcare staff were recruited to complete a short survey with closed and open-ended items. Descriptive statistics were used to analyze the quantitative survey responses and thematic analysis was used to analyze qualitative responses. Approximately 94% of staff indicated they had read MLMS notes and over 86% agreed or strongly agreed that reading the notes was a good use of their clinical time and helped them provide better treatment or care. Staff also described making more personalized decisions about the plan of treatment or care delivery after knowing the Veteran better from their story. Our findings suggest the MLMS program has been well sustained over time, and the use of patient stories in healthcare may be a valuable, practical, and sustainable tool to support the delivery of patient-centered care.

A systematic review and meta-analysis of psychological interventions to improve mental wellbeing

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.

Actual Solidarity through Virtual Support: A Pilot Descriptive Study of an Online Support Group for Bereaved Parents

Background: Hospital-based support for bereaved parents is regarded as best practice. Little is known about parental perceptions or programmatic potential of online grief support. Objectives: To learn from bereaved parent participants' experiences with an online support group to include perceptions of technology acceptance and group communication dynamics. Design: Descriptive study reporting on an eight-week online bereavement support group offered during summer 2020. Subjects and Setting: Inclusive of six bereaved parent participants in the Midwestern United States. Measurements: Post-intervention survey consisting of 49-items with the Technology Acceptance Model and Other Communicated Perspective-Taking Ability instruments embedded. Results: Five bereaved mothers and one father (mean age 32 years) residing an average 126 miles from hospital participated in an online support group in a timeframe seven months to one year from the death of their child. Intensity of grief emotion (5/6 parents) and physical distance (4/6 parents) were notable barriers to in-person visits to the hospital, where bereavement support was to be offered. Parents uniformly reported feeling benefit from the program and satisfaction with the program. Respondents self-reported gaining improved communication (4/6 parents), coping (3/6 parents), peer support (3/6 parents), education (3/6 parents), and emotional expression (3/6 parents). Mean scores on the technology acceptance and communication experiences scales were 4.7/5. The virtual format was an acceptable modality with perceived supportive interpersonal communication dynamics. Conclusion: Pediatric palliative care teams may consider the offering of online bereavement support groups. Further research is warranted on the impact and outcomes of online bereavement support groups for bereaved parents.

Communicated Sense-making After Miscarriage: A Dyadic Analysis of Spousal Communicated Perspective-Taking, Well-being, and Parenting Role Salience

Grounded in communicated sense-making (CSM) theorizing, we investigated communicated perspective-taking (CPT; i.e., conversational partners' attendance to and confirmation of each other's views) in association with individual and relational well-being in married couples who had miscarried (n = 183; N = 366). Actor-partner interdependence modeling revealed husbands' perceptions of wives' CPT were positively related to husbands' positive affect about the miscarriage and both spouses' relational satisfaction, as well as negatively associated with wives' positive affect. Wives' perceptions of husbands' CPT related positively to their own relational satisfaction and negatively to husbands' negative affect. Analyses revealed identification as a parent to the miscarried child (i.e., "parenting role salience") positively moderated the relationship between CPT and relational satisfaction. Implications for advancing CSM theorizing in health contexts and practical applications are explored.

Self-Disclosing Trauma and Post-Traumatic Stress Symptoms in Couples: A Longitudinal Study

OBJECTIVE

Most research concerning the implications of self-disclosure on trauma's aftermath has focused on the salubrious effects disclosure may foster for the primary victim. However, the manner in which recipients of disclosure are symptomatically affected by it remains unexamined. Of particular interest are spouses who are often the primary support providers and are therefore susceptible to secondary traumatization. Assessing posttraumatic stress symptoms (PTSS) and self-disclosure among traumatized veterans and their wives, the current longitudinal study begins to fill this gap in the literature.

METHOD

A total of 220 couples consisting of Israeli veterans, of whom 128 were former prisoners of war (ex-POWs) and 92 were combatants, and their wives were examined. PTSS and self-disclosure of both partners were assessed 30 and 35 years after the war using the Posttraumatic Stress Disorder Inventory (PTSD-I; Solomon et al., 1993) and the Self-Disclosure Index (SDI; Miller, Berg, & Archer, 1983), respectively. Analyses included Pearson intercorrelations analyses and four stepwise hierarchical multiple regression analyses.

RESULTS

Findings indicated that increments in veterans' disclosure are not only consistently associated with the reduction of their wives' PTSS but may also explain and predict some of the change in the wives' PTSS over time. However, such a longitudinal effect was not evident concerning the veterans' PTSS.

CONCLUSION

Traumatized ex-POWs' and combatants' self-disclosure within the marital relationship may contribute to the amelioration of their wives' secondary traumatization, and thus may be a goal worth pursuing in therapy. However, more research is needed to further understand this relation.