Neuroticism and responses to social comparison among cancer patients

The present study examined how the effects of three audiotapes containing different types of social comparison information on the mood of cancer patients depended on the level of neuroticism. On the procedural tape, a man and woman discussed the process of radiation therapy, on the emotion tape, they focussed on emotional reactions to their illness and treatment, while on the coping tape they focussed on the way they had been coping. A validation study among 115 students showed that the tapes were perceived as they were intended. The main study was conducted among 226 patients who were about to undergo radiation therapy. Compared to patients in the control group, as patients were higher in neuroticism, they reported less negative mood after listening to the procedural and the coping tape. Furthermore, as patients were higher in neuroticism, they reported less negative mood after listening to the coping tape than to the emotion tape. Copyright © 2009 John Wiley & Sons, Ltd.

Affective Consequences of Social Comparisons by Women With Breast Cancer: An Experiment

Objective

People with severe illness often meet and compare themselves with other patients. Some of these comparison standards do well, others do poorly. Such comparisons could have positive as well as negative consequences depending on whether people identify or contrast from the standard. In the present study, we examine whether patients with breast cancer can benefit from comparisons by engaging in favorable comparison processes.

Design

102 women diagnosed with breast cancer were randomly assigned to read a (fictitious) self-report from a well or poorly adjusted breast cancer patient.

Main Outcome Measures

Participants reported their affective reaction (mood, anxiety, depression) and specified their comparison process (identification or contrast).

Results

In general, participants engaged in favorable comparison processes by contrasting predominantly with poorly adjusted patients, and identifying with well-adjusted ones.

Participants’ Mood Assimilated to the Standard

Participants reported more positive mood after having been exposed to the well-adjusted than the poorly adjusted standard.

Anxiety and Depression Varied With the Type of Comparison Process

It was lower the more they avoided unfavorable comparisons (contrasting with the well-adjusted patient and identifying with the poorly adjusted one).

Conclusion

Patients adjust their comparison processes to the standard to experience favorable comparisons. Especially avoiding unfavorable comparison processes reduces the risk of negative consequences after encountering other patients. Thus, patients may profit from comparisons as long as they engage in the right process.

Social comparisons predict health-related quality of life and depressive symptoms across the first year of breast cancer treatment

BACKGROUND

Social comparisons (SCs) are common among cancer patients, but their prospective associations are not well understood. This study examined concurrent and prospective relationships of SCs with health-related quality of life (HRQOL) and depressive symptoms during the first year of breast cancer treatment.

METHODS

Nonmetastatic breast cancer patients (N = 240) enrolled in a larger intervention trial reported on the frequencies of SCs postsurgery (T1) and 6 months later (T2). HRQOL and depressive symptoms were assessed at T1, T2, and 12 months after T1 (T3). Path analysis via structural equation modeling was used to assess three models relating SCs to HRQOL and depressive symptoms from T1-T2, T1-T3, and T2-T3, controlling for stage of disease, intervention condition, and dispositional optimism.

RESULTS

Upward contrast SCs were associated with poorer concurrent HRQOL at T1 and T2, and with more concurrent depressive symptoms at T2. However, upward contrast SC at T1 predicted better T2 and T3 HRQOL. Upward identification SC at T1 predicted more T2 depressive symptoms, and at T2 was associated with poorer concurrent HRQOL and more concurrent depressive symptoms. Downward identification SCs at T1 were associated with poorer concurrent HRQOL. Downward identification SCs at T2 predicted poorer T3 HRQOL.

CONCLUSIONS

Upward SCs were related to compromised concurrent psychosocial well-being, but prospective effects varied by the interpretation of the comparison (ie, contrast vs identification). Findings have implications for the development and deployment of group-based psychosocial interventions during the early phases of survivorship, during which opportunities for SC are prevalent.

A Cross-Sectional Study of Psychological Comparison Processes That May Underlie the Acceptance of Chronic Pain

Acceptance of chronic pain varies between patients but may also be expected to develop and change within patients. In this latter framework, the present study explored three psychological processes that may contribute to changes in acceptance: social comparisons, temporal comparisons and counterfactual comparisons. In general, these comparisons are used to cope with negative life events, and they may also play a role in acceptance of pain. In this study, the two subscales of the Chronic Pain Acceptance Questionnaire (Activity Engagement and Pain Willingness) were complemented with a scale of Affective Acceptance. Using linear regression analyses, data from these three acceptance scales were regressed on three scales of temporal comparison processes, four scales of social comparison processes and one scale of counterfactual comparisons. The results showed that the comparison processes explained up to 37% of the variance in acceptance, especially a higher frequency of thinking of one's present condition in relation to a condition in the past, and feeling bad when comparing with others who are doing better, were consistently related to lower acceptance. These explorative results may inspire experimental studies to influence comparison processes and, eventually, to address those comparison processes in interventions for patients with chronic pain to improve acceptance. Copyright © 2015 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

In addition to beliefs indicating Activity Engagement and Pain Willingness, Affective acceptance of pain may also be a relevant dimension and manifestation of acceptance Social comparisons, temporal comparisons and counterfactual comparisons are related to acceptance of pain In patients with pain psychological comparison processes can be relevant in diagnosing possible causes of non-optimal acceptance of chronic pain Practitioners may try to influence each of the three types of psychological comparison processes in individuals and observe the effects.

Exploring positive adjustment in people with spinal cord injury

This study explored adjustment in people with spinal cord injury; data from four focus groups are presented. Thematic analysis revealed four themes, managing goals and expectations, comparison with others, feeling useful and acceptance, showing participants positively engaged in life, positively interpreted social comparison information and set realistic goals and expectations. These positive strategies show support for adjustment theories, such as the Cognitive Adaptation Theory, the Control Process Theory and Response Shift Theory. These results also provide insight into the adjustment process of a person with spinal cord injury and may be useful in tailoring support during rehabilitation.

Social comparisons in novel situations: finding inspiration during life transitions

The authors propose that individuals transitioning to a novel environment will prefer upward comparisons, particularly those made with individuals who have experienced a similar transition. Such comparisons help to reduce uncertainty and demonstrate that future success is possible. Study 1 found that individuals facing transitions to unfamiliar situations seek upward comparisons as a result of their uncertainty. Study 2 demonstrated that individuals who perceive themselves to be making a significant life transition are especially motivated by upward comparisons. Study 3 provided evidence that upward comparisons are especially inspiring to individuals making a transition to a novel cultural environment. Study 4 provided experimental evidence that individuals in a novel cultural environment are particularly inspired by upward comparisons with other newcomers. These studies suggest that upward comparisons with individuals who have experienced a similar transition enhance individuals' sense of control over future outcomes and play a key role during adjustment to novel environments.

Social comparisons and chronic illness: research synthesis and clinical implications

The chronically ill patient must adjust to new life circumstances and manage ongoing threats to personal health. Patients often make comparisons with each other, which can have effects on their psychological and physical well-being. One question is whether health psychologists can develop interventions to strategically facilitate the use of such comparisons to optimise adjustment. This paper critically reviews evidence on patients' comparisons in studies using selection, narration and reaction methods. Discussion focuses on gaps in the empirical literature and describes some new basic concepts in social comparison, which may advance knowledge about the process in medical patients. Recommendations also are provided about the kinds of studies needed to inform the future design of effective social comparison interventions.

Validation of a quality-of-life scale for women with bladder pain syndrome/interstitial cystitis

PURPOSE

To validate a disease-specific scale to measure the impact of symptoms of bladder pain syndrome/interstitial cystitis (BPS/IC), a condition that affects up to 6.5% of U.S. women.

METHODS

Participants were drawn from the RAND Interstitial Cystitis Epidemiology (RICE) Study, a telephone probability survey of 146,231 US households. Women who met RICE BPS/IC symptom criteria (n = 3,397) completed the 6-item RAND Bladder Symptom Impact scale (RICE BSI-6). The RICE BSI-6 was adapted from a scale used to assess the impact of diabetes on life and sexuality and modified based on expert input on face validity and focus group work; items specific to diabetic symptoms were eliminated. Validated scales of symptom severity, mental- and physical-health-related quality of life (QoL), depression, coping, and perceived control were used to assess convergent validity.

RESULTS

The RICE BSI-6 (α = 0.92) was significantly related to greater symptom severity, worse general mental- and physical-health-related QoL, more severe depression symptoms, and lower perceived control over life in general and over BPS/IC symptoms (P values < .05). It was also associated with less use of distancing coping (P < .05).

CONCLUSION

The RICE BSI-6 shows excellent internal consistency and strong convergent validity. It can be used to examine the effects of psychosocial and treatment interventions on QoL among women with BPS/IC.

Enabling mutual helping? Examining variable needs for facilitated peer support

OBJECTIVE

To examine uses of peer support among people living with a urological cancer.

METHODS

26 qualitative interviews investigating experiences of needing and receiving information and support among people who had and who had not used a new urological cancer centre and its various peer support opportunities.

RESULTS

Study participants reported varied needs for engagement with facilitated peer support, and suggested these depended on the severity and burden of their disease and treatment, the support they derived from existing networks, and their sense of coping. A minority reported avoiding speaking with other patients in order to protect their own or the other patients' emotional wellbeing.

CONCLUSION

Desire for facilitated peer support is variable, and both giving and receiving support may have negative as well as positive consequences. These may depend on the nature of social comparisons that peer support interventions prompt, and the varying ways people interpret these.

PRACTICAL IMPLICATIONS

Services offering facilitated peer support should recognise people's variable and contingent needs for support, and acknowledge the potential disadvantages of facilitated peer support for some patients.

Follow-up effects of social comparison information on the quality of life of cancer patients: the moderating role of social comparison orientation

OBJECTIVE

To examine how social comparison orientation (SCO) moderates the effects of three types of social comparison information on the global quality of life of cancer patients 2 weeks and 3 months later.

DESIGN

Cancer patients (n=226) were provided with social comparison information just prior to undergoing radiation therapy, using audiotapes. Each participant was confronted with one of three tapes: (1) focusing on procedural aspects, (2) focusing on emotional reactions and (3) focusing on coping strategies.

MAIN OUTCOME MEASURES

Quality of life as measured with the Cantril self-anchoring scale [Cantril, H. (1965). The pattern of human concerns. New Brunswick, NJ: Rutgers University Press].

RESULTS

With increasing SCO, a lower quality of life was reported after listening to the emotion tape, while a higher quality of life was reported after listening to the coping tape. These effects were found 2 weeks as well as 3 months after the radiation therapy had ended.

CONCLUSION

Social comparison information may have longitudinal effects on quality of life, but these effects are to an important extent dependent on the nature of the information and individual differences in SCO.

The process and effect of supportive message expression and reception in online breast cancer support groups

OBJECTIVE

To better understand the process and effect of social support exchanges within computer-mediated social support (CMSS) groups for breast cancer patients, this study examines (1) the dynamic interplay between emotional support giving and receiving and (2) the relative effects of emotional support giving and receiving on patients' psychosocial health outcomes.

METHODS

Data was collected from 177 patients who participated in online cancer support groups within the Comprehensive Health Enhancement Support System (CHESS) during the 4-month intervention. Data included (1) pretest and/or post-test survey scores of demographic, disease-related, and psychosocial factors, (2) automatically collected CHESS usage data, and (3) computer-aided content analysis of social support messages posts.

RESULTS

Hierarchical regression analyses revealed that those who receive higher levels of support from others have fewer breast cancer-related concerns (β = - 0.15, p<0.05), while those who give higher levels of support to others reframe their own problems in a positive light and adopt more positive strategies for coping (β = 0.16, p<0.05). In addition to these positive effects, partial correlation analysis indicated that these two supportive behaviors are reciprocal.

CONCLUSIONS

We concluded that supportive exchanges of receiving and giving play positive, but different, roles in predicting psychosocial health outcomes. Moreover, emotional support giving and receiving tend to reinforce each other. Our findings help practitioners, health-care providers, and health system designers make sense of diverse social support processes among cancer patients participating within CMSS groups.

Social comparison as a coping strategy among caregivers of eating disorder patients

The aim of the study was to determine any gender differences in the social comparisons made by caregivers of eating disorder patients and to analyse the relationship between social comparison and personality, age of caregivers, self-esteem, duration of illness, duration of treatment and perceived health and quality of life. We also explored the possibility of classifying caregivers according to these variables. Comparison strategies were analysed in a sample of 96 caregivers of eating disorder patients. The social comparison during illness scale, visual analogue scales of health and quality of life, self-esteem scale of Rosenberg and Eysenck Personality Questionnaire were used. In order to explore possible groupings a cluster analysis was performed. A significant correlation between the use of more unfavourable strategies, neuroticism and low self-esteem was found. Women adopted worse strategies and the cluster analysis revealed two sub-groups with respect to comparisons, personality, self-esteem, self-perceived health status and quality of life. The finding of subgroups associated with worse comparison strategies, higher neuroticism, lower self-esteem and a poorer self-perception of health and quality of life could have repercussions as regards the prognosis of eating disorders and, at all events, should be taken into account during therapeutic work with families.

Social Comparison within Self-help Groups

This study used a qualitative approach to examine the experiences of parents participating as members of the Duchenne Family Support Group (DFSG), with a focus on whether social comparison occurred within this group. Eight parents were interviewed about their experiences of being a member. Thematic analysis was used to identify themes inductively. The study uncovered a wide range of social comparisons, including upward and downward comparisons on illness and coping dimensions, with both positive and negative affects. The results highlighted the complexity of socially comparing within the context of chronic illness, particularly in an illness in which deterioration is inevitable.

Exploring the use of social comparison by individuals recovering from traumatic brain injury

OBJECTIVE

To explore if and how individuals with traumatic brain injury (TBI) use social comparison during adjustment to disability. It was hypothesized that comparison activity may change with time since injury.

METHODS

Fifty-eight participants with TBI were surveyed within 1 or 6 months of discharge from inpatient rehabilitation. Group responses to instruments measuring social comparison and other measures of emotional and physical functioning were compared.

RESULTS

Both groups expressed a need for social comparison at a rate comparable to non-clinical populations. The group surveyed at 6 months expressed a greater need for social comparison and scored lower on a measure of mental health, as compared to the group surveyed earlier.

CONCLUSIONS

Individuals with TBI appear to successfully use social comparison, at least early in recovery, with a possible reduction in effectiveness of use with increased time from injury. Possible mediating factors and implications for adjustment and future study are discussed.

An interpretative phenomenological analysis of adaptation to recurrent venous thrombosis and heritable thrombophilia: the importance of multi-causal models and perceptions of primary and secondary control

Venous thromboembolic disease (VTE) is a serious, life-threatening condition and a major cause of mortality and morbidity. Heritable thrombophilia increases risk of recurrent VTE. The present study employed Interpretative Phenomenological Analysis (IPA) to explore adaptation to recurrent VTE and heritable thrombophilia in six female patients. Three main themes were identified focusing on: (1) patients' multi-causal models of VTE and the maintenance of; (2) primary control; and (3) secondary control as facilitators of adjustment. Overall, genetic testing following recurrent VTE did not have a negative impact on patients. One area of concern, however, related to passing on the susceptibility to children.

Prostate Cancer Support Groups

This article provides an overview of research literature related to cancer support groups, with particular reference to prostate cancer groups. Randomized studies of cancer support groups primarily focus on short-term psychoeducational and/or supportive/expressive groups for women with breast cancer. Many of these studies suggest that the interventions lead to a pronounced improvement in psychological functioning and may in some instances increase longevity. Regarding prostate cancer support group members, information and education are especially valued. Open-ended, psychoeducational groups with large meetings, expert speakers, and structured, efficient organizations appear most beneficial to prostate cancer group members. The literature only partially answers a number of significant questions, including the types of group most appropriate for people with specific diseases, process variables most significant to the success of groups, and specific factors that are barriers to group involvement by certain populations.

The development of audio-visual materials to prepare patients for medical procedures: an oncology application

This paper describes a systematic process for the development of educational audio-visual materials that are designed to prepare patients for potentially threatening procedures. Literature relating to the preparation of patients for potentially threatening medical procedures, psychological theory, theory of diffusion of innovations and patient information was examined. Four key principles were identified as being important: (1) stakeholder consultation, (2) provision of information to prepare patients for the medical procedure, (3) evidence-based content, and (4) promotion of patient confidence. These principles are described along with an example of the development of an audio-visual resource to prepare patients for chemotherapy treatment. Using this example, practical strategies for the application of each of the principles are described. The principles and strategies described may provide a practical, evidence-based guide to the development of other types of patient audio-visual materials.

How does social comparison within a self-help group influence adjustment to chronic illness? A longitudinal study

Despite the growing popularity of self-help groups for people with chronic illness, there has been surprisingly little research into how these may support adjustment to illness. This study investigated the role that social comparison, occurring within a self-help group, may play in adjustment to chronic illness. A model of adjustment based on control process theory and response shift theory was tested to determine whether social comparisons predicted adjustment after controlling for the catalyst for adjustment (disease severity) and antecedents (demographic and psychological factors). A sample of 301 people with Ménière's disease who were members of the Ménière's Society UK completed questionnaires at baseline and 10-month follow-up assessing adjustment, defined for this study as functional and goal-oriented quality of life. At baseline, they also completed measures of the predictor variables i.e. the antecedents (age, sex, living circumstances, duration of self-help group membership, self-esteem, optimism and perceived control over illness), the catalyst (severity of vertigo, tinnitus, hearing loss and fullness in the ear) and mechanisms of social comparison within the self-help group. The social comparison variables included the extent to which self-help group resources were used, and whether reading about other members' experiences induced positive or negative feelings. Cross-sectional results showed that positive social comparison was indeed associated with better adjustment after controlling for all the other baseline variables, while negative social comparison was associated with worse adjustment. However, greater levels of social comparison at baseline were associated with a deteriorating quality of life over the 10-month follow-up period. Alternative explanations for these findings are discussed.

Factors important for the measurement of social comparison in chronic illness: a mixed-methods study

OBJECTIVES

The aim of this study was to examine social comparison in illness using a mixed-methods approach that combined inductive exploration of how people used social comparison in this self-help group with a quantitative study of social comparison processes and their relationship to quality of life.

METHODS

The qualitative study involved 15 semi-structured interviews with people with Ménière's disease. Themes from the analysis of the interviews informed the development of the Social Comparison in Illness Scale (SCIS), which was then validated in a questionnaire study, in which participants with Ménière's disease (n = 196) completed the SCIS, the previously validated Identification/Contrast social comparison scale, and the SF-36 health status questionnaire.

RESULTS

The qualitative study uncovered a wide range of forms of social comparison, including upward, downward and lateral comparison on illness and coping dimensions, as well as comparing solely for informational purposes. The quantitative study indicated that these varied directions and dimensions of social comparison could be mapped onto five reliable categories that were related to quality of life: upward positive and downward positive comparison, upward negative and downward negative comparison, and comparing for information.

DISCUSSION

These analyses highlight the complexity of socially comparing in chronic illness, but also confirm the validity of the Identification/Contrast model of social comparison in this context.

Boosting Strategies: Enhancing the Self-Esteem of Individuals With Catastrophic Illnesses and Injuries

This qualitative study used grounded theory methods to determine how individuals were able to live with catastrophic illnesses and injuries. Twenty-eight participants were interviewed for stories of how they endured their circumstances. Although several strategies were used, this article describes a strategy entitled "boosting," which outlines the affected individuals' efforts to improve their self-esteem, which helped them bear their circumstances. Boosting has some relationship to social comparison theory. Implications for nurses and the importance of awareness of this communication need for patients are discussed.