Caring for critically ill patients with a mental illness: A discursive paper providing an overview and case exploration of the delivery of intensive care to people with psychiatric comorbidity

AIM

To address the need for additional education in the management of mental illness in the critical care setting by providing a broad overview of the interrelationship between critical illness and mental illness. The paper also offers practical advice to support critical care staff in managing patients with mental illness in critical care by discussing two hypothetical case scenarios involving aggressive and disorganised behaviour. People living with mental illness are over-represented among critically unwell patients and experience worse outcomes, contributing to a life expectancy up to 30 years shorter than their peers. Strategic documents call for these inequitable outcomes to be addressed. Staff working in intensive care units (ICUs) possess advanced knowledge and specialist skills in managing critical illness but have reported limited confidence in managing patients with comorbid mental illness.

DESIGN & METHODS

A discursive paper, drawing on clinical experience and research of the authors and current literature.

RESULTS

Like all people, patients with mental illnesses draw on their cognitive, behavioural, social and spiritual resources to cope with their experiences during critical illness. However, they may have fewer resources available due to co-morbid mental illness, a history of trauma and social disadvantage. By identifying and sensitively addressing patients' underlying needs in a trauma-informed way, demonstrating respect and maximising patient autonomy, staff can reduce distress and disruptive behaviours and promote recovery. Caring for patients who are distressed and/or display challenging behaviours can evoke strong and unpleasant emotional responses. Self-care is fundamental to maintaining a compassionate approach and effective clinical judgement. Staff should be enabled to accept and acknowledge emotional responses and access support-informally with peers and/or through formal mechanisms as needed. Organisational leadership and endorsement of the principles of equitable care are critical to creation of the environment needed to improve outcomes for staff and patients.

RELEVANCE TO CLINICAL PRACTICE

ICU nurses hold an important role in the care of patients with critical illnesses and are ideally placed to empower, advocate for and comfort those patients also living with mental illness. To perform these tasks optimally and sustainably, health services have a responsibility to provide nursing staff with adequate education and training in the management of mental illnesses, and sufficient formal and informal support to maintain their own well-being while providing this care.

PATIENT AND PUBLIC INVOLVEMENT

This paper is grounded in accounts of patients with mental illness and clinicians providing care to patients with mental illness in critical care settings but there was no direct patient or public contribution.

How to Improve Others' Emotions: Reappraise and be Responsive

People often try to improve others' emotions. However, it is unclear which interpersonal emotion regulation strategies are most effective and why. In 121 candid dyadic conversations between undergraduate students via video conferencing, target participants recounted a stressful event to regulator participants. Three strategies used by regulators during these conversations to change targets' emotions were obtained from the regulator after the conversation: extrinsic reappraisal, extrinsic suppression, and extrinsic acceptance. Perceived regulator responsiveness was obtained from targets to examine the social consequences of extrinsic emotion regulation and its mediating role in successful extrinsic emotion regulation. We found that regulators' extrinsic reappraisal use was associated with improved target emotions measured across two distinct classes of outcomes: targets' emotions during the conversation and targets' perception that the regulator improved their emotions. Regulators' extrinsic suppression and acceptance, in contrast, were not related with improved target emotions or perceptions of improvement. Instead, all extrinsic regulatory strategies were associated with improved targets' emotions when mediated by targets' perceptions of regulator responsiveness. Finally, observer-ratings of regulators' extrinsic reappraisal and suppression use were found to be consistent with regulators' self-ratings and follow the same pattern of results on the outcome measures. These findings provide insight into why the social regulation of emotions can succeed or fail and hold implications for interventions aimed at guiding people toward more successfully improving others' emotions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-023-00183-4.

Mediation by coping style in the association between stressful life events and depressive symptoms in young adults

PURPOSE

The association between stressful life events and depressive symptoms is well-established, but the role of coping style in this association is less clear. We examined whether problem-focused, emotion-focused or avoidant coping style mediated and/or moderated the association in young adults.

METHODS

Data were drawn from a 20-year longitudinal study that included 1294 students' age 12-13 years recruited in 1999-2000 from ten high schools in Montreal, Canada. Herein we report an analysis that included 782 participants aged 24 years on average with data on covariates collected at age 20. Using VanderWeele's four-way decomposition approach, the total effect of stressful life events on depressive symptoms considering coping styles was decomposed into four components: moderation only, mediation only, mediated interaction, no mediation or moderation.

RESULTS

We observed mediation only by emotion-focused coping ([Formula: see text](95%CI) = 0.15(0.04, 0.24)) suggestive that individuals who experienced more stressful life events also reported greater use of emotion-focused coping and higher levels of depressive symptoms. We found moderation only by problem-focused coping ([Formula: see text](95%CI) = - 1.51(- 2.40, - 0.53)) and by emotion-focused coping ([Formula: see text](95%CI) = 1.16(0.57, 1.69). These results suggest that individuals reporting more problem-focused coping experienced fewer depressive symptoms after exposure to stressful life events; those reporting more emotion-focused coping experienced more depressive symptoms. Avoidant coping did not mediate or moderate the association between stressful life events and depressive symptoms.

CONCLUSION

Interventions that aim to reduce depressive symptoms in young adults who experience stressful life events may need to reinforce problem-focused coping and minimize emotion-focused coping strategies.

Communicating emotional distress experienced by adolescents between adolescents and their mothers: Patterns and links with adolescents' emotional distress

This research proposes the construct of Communication Patterns of adolescents' emotional distress (CPAED) between adolescents and their parents, describing situations in which open or defective dialog about adolescents' emotions following distressful events are formed between adolescents and their parents. By addressing adolescents' perceptions of CPAED in adolescents and their mothers, we developed a valid and reliable scale to assess the hypothesized CPAED theoretical framework. Factor analyses in Study 1 (EFA; N = 257, M_age = 15.66 years old, SD = 0.35) and Study 2 (CFA; initial N = 684; M_age = 14.08, SD = 0.45) suggested three factors: a) Active and Reactive Emotion Sharing (ARES), referring to adolescents' active sharing of emotion or reactive sharing in the face of maternal inquiry; b) Lack of Solicitation by mothers (LS), tracking mothers' avoidance of communication; and c) Lack of Response by adolescents (LR), describing adolescents' avoidance of communication even when asked by mothers. Moreover, Study 2 documented that CPAED were linked to maternal emotion socialization practices (i.e., emotion expressivity and responses to adolescents' negative emotions) and adolescents' negative emotion expression. Study 2 found that ARES predicted decreased emotional distress in adolescents, whereas LS and LR predicted increased emotional distress accordingly; and the three factors of CPAED incrementally predicted adolescents' emotional distress over and beyond other theoretically relevant predictors.

Journal Writing by Families of Critically Ill Patients: An Integrative Review

BACKGROUND

Families experience high levels of stress during a loved one's critical illness.

OBJECTIVE

To provide an overview of current evidence on the use of journal writing as a coping mechanism for family members during a loved one's critical illness in a neonatal, pediatric, or adult intensive care unit.

METHODS

Five databases (MEDLINE, PsycINFO, CINAHL, APA PsycArticles, and Health Source: Nursing/Academic Edition) were searched to identify studies examining the benefits of journal writing for family members of critically ill patients. Eight eligible studies reported data from 426 relatives of critically ill patients.

RESULTS

Regarding quality assessment, the quantitative studies met 73.1% of relevant quality criteria, whereas qualitative studies met 81.3%. Mixed-methods studies met 82.4% of quantitative and 55% of qualitative criteria. Various key themes were identified: communication and understanding, connection to the patient, emotional expression, creating something meaningful, and the importance of pictures and staff entries. Overall, writing in a diary seems to be beneficial for reducing psychological distress and posttraumatic stress disorder, but none of the studies found that it significantly decreased anxiety or depression.

CONCLUSIONS

The findings of this review suggest that having family members of critically ill patients write in a diary is a simple and cost-effective intervention that may improve their psychological outcomes. Critical care nurses are in a position to educate families about the potential benefits of writing in a diary. Future research would be valuable regarding the benefits of using a diary and an optimal approach for doing so in this population.

A systematic review on social constraints in the context of cancer

This review aims to identify, summarise and critically evaluate studies that examined moderators or mediators of the relationship between social constraints and cancer adjustment. A database search was conducted to identify eligible studies published between inception and November 2019. A narrative synthesis of the included studies was conducted. We identified 18 papers, comprising 6933 participants (Mage = 55.70) with different types of cancer (mainly breast cancer). All of the studies used the Social Constraints Scale. Our synthesis shows that the association between social constraints and cancer adjustment is likely to be moderated or mediated by different cognitive (e.g. avoidant coping, intrusive thoughts) and emotional (e.g. emotionality, negative affect) variables. The importance of the moderators and mediators found in this study should be further examined by employing more sophisticated data analytic strategies to assess mediation and by collecting longitudinal data in order to better disentangle the complex associations among variables. However, some important variables were identified as potential targets of interventions for patients facing cancer.

Our dreams, our selves: automatic analysis of dream reports

Sleep scientists have shown that dreaming helps people improve their waking lives, and they have done so by developing sophisticated content analysis scales. Dream analysis entails time-consuming manual annotation of text. That is why dream reports have been recently mined with algorithms, and these algorithms focused on identifying emotions. In so doing, researchers have not tackled two main technical challenges though: (i) how to mine aspects of dream reports that research has found important, such as characters and interactions; and (ii) how to do so in a principled way grounded in the literature. To tackle these challenges, we designed a tool that automatically scores dream reports by operationalizing the widely used dream analysis scale by Hall and Van de Castle. We validated the tool's effectiveness on hand-annotated dream reports (the average error is 0.24), scored 24 000 reports-far more than any previous study-and tested what sleep scientists call the 'continuity hypothesis' at this unprecedented scale: we found supporting evidence that dreams are a continuation of what happens in everyday life. Our results suggest that it is possible to quantify important aspects of dreams, making it possible to build technologies that bridge the current gap between real life and dreaming.

Advanced Cancer Patients' Changes in Accurate Prognostic Understanding and Their Psychological Well-Being

CONTEXT

Clinicians often worry that patients' recognition of the terminal nature of their illness may impair psychological well-being.

OBJECTIVES

To determine if such recognition was associated with decrements to psychological well-being that persisted over time.

METHODS

About 87 patients with advanced cancer, with an oncologist-expected life expectancy of less than six months, were assessed before and after an oncology visit to discuss cancer restaging scan results and again at follow-up (median time between assessments, approximately six weeks). Prognostic understanding (PU) was assessed at previsit and postvisit, and a change score was computed. Psychological well-being was assessed at pre, post, and follow-up, and two change scores were computed (post minus pre; follow-up minus post).

RESULTS

Changes toward more accurate PU was associated with a corresponding initial decline in psychological well-being (r = -0.33; P < 0.01) but thereafter was associated with subsequent improvements (r = 0.40; P < 0.001). This pattern remained controlling for potential confounds. Patients showed different patterns of psychological well-being change (F = 3.07, P = 0.05; F = 6.54, P < 0.01): among patients with improved PU accuracy, well-being initially decreased but subsequently recovered; by contrast, among patients with stable PU accuracy, well-being remained relatively unchanged, and among patients with decrements in PU accuracy, well-being initially improved but subsequently declined.

CONCLUSION

Improved PU may be associated with initial decrements in psychological well-being, followed by patients rebounding to baseline levels. Concerns about lasting psychological harm may not need to be a deterrent to having prognostic discussions with patients.

The consequences of sharing

People constantly share information with others, whether that information is about themselves, others, or the world at large. This review offers a framework for considering how these sharing behaviors produce two types of consequences - intrapersonal outcomes (which affect the sharer internally) and interpersonal outcomes (which affect the sharer's relationships) - and how these consequences depend on whether the content shared is positive or negative in valence. In doing so, the article presents a synthesis of prior research relevant to this organizing framework, and concludes by highlighting opportunities for further investigation.

Adaptive Reflection on Negative Emotional Experiences: Convergences and Divergence Between the Processing-Mode Theory and the Theory of Self-Distancing Reflection

Reflecting on negative emotional experiences can be adaptive but it can also maintain or intensify detrimental emotional states. Which factors determine whether reflection can have one consequence or another is unclear. This study focused on two research programs that have concentrated on this topic in the last decades: processing-mode theory (PMT) and self-distancing theory (SDT). The article described and contrasted both programs and their findings. The promising results that PMT and SDT have achieved in identifying the differences between the forms of adaptive and maladaptive reflection are highlighted. Likewise, the disconcerting contradictions observed between both programs that make integrating the findings difficult are indicated. The PMT states that adaptive reflection is concrete, and it is focused on the how of the experience. The SDT states that adaptive reflection is self-distanced and focused on the global meaning of the experience. The article finishes by indicating possible explanations for these apparent contradictions and outlines the challenges to be solved to improve comprehension of the topic.

The Emotional Approach Coping Scales in Chinese: Validation, Psychometric Properties, and Measurement Invariance

American and Chinese literatures on emotion-focused coping show inconsistent associations with distress, attributable to criterion contamination problems with measures. This problem was remedied by the American Emotional Approach Coping (EAC) scales, which are not confounded with distress; however, there is no Chinese counterpart. The EAC is of theoretical interest for exploring cross-cultural models of psychological and physical health since it allows one to measure emotion processing (theoretically lowering distress) without emotion expression (maintaining collectivist group harmony). In the present study, the EAC scales were translated into Chinese and their factorial, criterion, and discriminant validity as well as measurement invariance of the two versions were examined in 353 Chinese and 491 Americans. Previous validational findings for American EAC scales were replicated and configural and metric invariance demonstrated, supporting the comparable reliability and validity of the Chinese EAC scales. Chinese showed fewer gender differences than Americans.

The assessment experience of spousal dementia care-givers: ‘It's made me realise that I am a person also’

This article is based on a study that used a validated care-giver assessment instrument known as ‘The C.A.R.E. (Caregivers’ Aspirations, Realities, and Expectations) Tool’ to understand its usefulness in working with older adults caring for a spouse with cognitive impairment. It draws on data collected as part of a larger, quasi-experimental pre- and post-test study examining the impact of a care-giver assessment on older spousal care-givers of a partner with cognitive impairment. One hundred community-living individuals (average age of 74) participated in the study. Participants met with a third-year nursing student who administered The C.A.R.E. Tool. Within three to seven days following this, a research team member conducted a semi-structured interview by telephone. This interview provided participants with the opportunity to comment on their experience and the usefulness of The C.A.R.E. Tool. Transcriptions of the interviews were analysed using a thematic analysis. Results indicate that the assessment experience was evaluated positively by most participants. Two broad themes emerged: assessment encourages care-givers to take stock of their situation, and it provides a relationship with a caring professional. In particular, the assessment experience gave these care-givers to have the opportunity to reflect, while expressing emotions and developing awareness, and provided them with an appreciated relationship with a caring professional who helped to validate and normalise their situation. For care-givers, the results suggest that assessment may serve as a catalyst for taking action in their care-giving situation or turning to services for help. For practitioners, assessment may increase awareness of the experience of spousal care-givers, potentially leading to interventions to support them. This study found that the attitudes and knowledge of practitioners play a role in care-givers’ experience of the assessment as positive. However, the goal of assessment must be clarified, as outcomes of other tools will differ depending on the aims.

Emotional approach coping and depressive symptoms in colorectal cancer patients: The role of the intimate relationship

This study examined whether emotional approach coping was associated with lower depressive symptoms, and whether intimacy moderated this association, in 121 married/partnered colorectal cancer (CRC) outpatients. Prospective analyses of survey data on emotional approach coping, depressive symptoms, and intimacy measured at baseline and 6-month follow-up showed that depressive symptoms were inversely related to processing, expression, and intimacy. At baseline, the association between processing and depressive symptoms was moderated by intimacy: greater processing was associated with lower depressive symptoms only for those in relatively high-intimacy relationships. Enhancing emotional approach coping efforts and relationship quality may benefit CRC patients' adjustment.

Adjusting to Chronic Health Conditions

Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.

The effect of expressive writing intervention for infertile couples: a randomized controlled trial

STUDY QUESTION

Is expressive writing intervention (EWI) efficacious in reducing distress and improving pregnancy rates for couples going through ART treatment?

SUMMARY ANSWER

Compared to controls, EWI statistically significantly reduced depressive symptoms but not anxiety and infertility-related distress.

WHAT IS KNOWN ALREADY

ART treatment is considered stressful. So far, various psychological interventions have been tested for their potential in reducing infertility-related distress and the results are generally positive. It remains unclear whether EWI, a brief and potentially cost-effective intervention, could be advantageous.

STUDY DESIGN SIZE, DURATION

Between November 2010 and July 2012, a total of 295 participants (163 women, 132 men) were randomly allocated to EWI or a neutral writing control group.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants were couples undergoing IVF/ICSI treatment. Single women and couples with Preimplantation Genetic Diagnosis or acute change of procedure from insemination to IVF, were excluded. EWI participants participated in three 20-min home-based writing exercises focusing on emotional disclosure in relation to infertility/fertility treatment (two sessions) and benefit finding (one session). Controls wrote non-emotionally in three 20-min sessions about their daily activities. The participants completed questionnaires at the beginning of treatment (t1), prior to the pregnancy test (t2), and 3 months later (t3). In total, 26.8% (79/295) were lost to follow-up. Mixed linear models were chosen to compare the two groups over time for psychological outcomes (depression, anxiety and infertility-related distress), and a Chi² test was employed in order to examine group differences in pregnancy rates MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and fifty-three participants received EWI (women = 83; men = 70) and 142 participants were allocated to the neutral writing control group (women = 83; men = 62). Both women and partners in the EWI group exhibited greater reductions in depressive symptoms compared with controls (P = 0.049; [CI 95%: -0.04; -0.01] Cohen's d = 0.27). The effect of EWI on anxiety did not reach statistical significance. Overall infertility-related distress increased marginally for the partners in the EWI group compared to the partners in the control group (P = 0.06; Cohen's d = 0.17). However, in relation to the personal subdomain, the increase was statistically significant (P = 0.01; Cohen's d = 0.24). EWI had no statistically significant effect on pregnancy rates with 42/83 (50.6%) achieving pregnancy in the EWI group compared with 40/80 (49.4%) in the control group (RR = 0.99 [CI 95% = 0.725, 1.341]; P = 0.94).

LIMITATIONS, REASONS FOR CAUTION

The results for depressive symptoms corresponded to a small effect size and the remaining results failed to reach statistical significance. This could be due to sample characteristics leading to a possible floor-effect, as we did not exclude participants with low levels of emotional distress at baseline. Furthermore, men showed increased infertility-related distress over time.

WIDER IMPLICATIONS OF THE FINDINGS

EWI is a potentially cost-effective and easy to implement home-based intervention, and even small effects may be relevant. When faced with infertility, EWI could thus be a relevant tool for alleviating depressive symptoms by allowing the expression of feelings about infertility that may be perceived as socially unacceptable. However, the implications do not seem to be applicable for men, who presented with increased infertility-related distress over time.

STUDY FUNDING/COMPETING INTERESTS

The present study was supported by research grants from Merck Sharpe and Dohme and The Danish Agency for Science Technology and Innovation as part of a publicly funded PhD. The funding bodies had no influence on the data collection, analysis or conclusions of the study. None of the authors have any conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov, trial no. NCT01187095.

TRIAL REGISTRATION DATE

7th September 2010 DATE OF FIRST PATIENT'S ENROLMENT: 23rd November 2010.

Emotional acceptance, inflammation, and sickness symptoms across the first two years following breast cancer diagnosis

PURPOSE

Breast cancer diagnosis and treatment are associated with increased inflammatory activity, which can induce sickness symptoms. We examined whether emotional acceptance moderates the association between proinflammatory cytokines and self-reported sickness symptoms in women recently diagnosed with breast cancer.

METHODS

Women (N=136) diagnosed with stage 0-III breast cancer within the previous 6months provided plasma samples and completed the FACT: Physical Well-Being Scale, as well as the Acceptance of Emotion Scale every 3months for 2years. At each time point, we quantified interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α using a high sensitivity multiplex assay.

RESULTS

Higher within-subject mean TNF-α across all time-points predicted higher mean sickness symptoms. At individual time-points, higher IL-6 and IL-8 levels were associated with higher sickness symptoms. Mean emotional acceptance across all time-points moderated the relationship between mean IL-8 and sickness symptoms, with sickness symptoms remaining persistently high in women with low emotional acceptance even when IL-8 levels were low. At individual time-points, emotional acceptance positively moderated the correlations of IL-8 and TNF-α with sickness symptoms, such that the associations between higher levels of these proinflammatory cytokines and higher sickness symptoms were attenuated when emotional acceptance was high.

CONCLUSION

Emotional acceptance was shown for the first time to moderate the associations of cytokines with sickness symptoms in breast cancer patients over time following diagnosis and treatment. The association between emotional acceptance and sickness symptoms was significantly different from zero but relatively small in comparison to the range of sickness symptoms. Results suggest that targeting emotion regulation may help to break the cycle between inflammation and sickness symptoms in women with breast cancer.

Functional status in patients with medically unexplained physical symptoms: Coping styles and their relationship with depression and anxiety

This study examined how coping styles are related to functional status in patients with medically unexplained physical symptoms and to what extent depression and anxiety account for this relationship. In 90 Dutch adult patients presenting medically unexplained physical symptoms, coping styles, health-related functional status, anxiety, and depression were measured. Multiple regression analyses and mediation analysis showed that coping styles were directly and indirectly related to functional status. In this relationship, depression and anxiety played an important role. The findings highlight the relevance of addressing coping styles, depression, and anxiety when targeting the functional status of patients with medically unexplained physical symptoms in clinical practice.

The feeling of the story: Narrating to regulate anger and sadness

Admonitions to tell one's story in order to feel better reflect the belief that narrative is an effective emotion regulation tool. The present studies evaluate the effectiveness of narrative for regulating sadness and anger, and provide quantitative comparisons of narrative with distraction, reappraisal, and reexposure. The results for sadness (n = 93) and anger (n = 89) reveal that narrative is effective at down-regulating negative emotions, particularly when narratives place events in the past tense and include positive emotions. The results suggest that if people tell the "right" kind of story about their experiences, narrative reduces emotional distress linked to those experiences.

Coping Strategies and Psychological Outcomes: The Moderating Effects of Personal Resiliency

Certain coping strategies alleviate stress and promote positive psychological outcomes, whereas others exacerbate stress and promote negative psychological outcomes. However, the efficacy of any given coping strategy may also depend on personal resiliency. This study examined whether personal resiliency moderated the effects of task-oriented, avoidance-oriented, and emotion-oriented coping strategies on measures of depression, anxiety, stress, positive affect, negative affect, and satisfaction with life. Results (N = 424 undergraduates) showed higher personal resiliency was associated with greater use of task-oriented coping strategies, which were in turn associated with more adaptive outcomes, and less reliance on nonconstructive emotion-oriented strategies, which in turn were associated with poorer psychological outcomes. In addition, individual differences in personal resiliency moderated the effects of task-oriented coping on negative affect and of emotion-oriented coping on negative affect and depression. Specifically, proactive task-oriented coping was associated with greater negative affect for people lower in personal resiliency. Moreover, high personal resiliency attenuated the negative effects of emotion-oriented coping on depression and negative affect. The effects of avoidance-oriented coping were mixed and were not associated with or dependent on levels of personal resiliency.

Project connect online: user and visitor experiences of an Internet-based intervention for women with breast cancer

OBJECTIVE

This study's purpose was to characterize the experience of patients with breast cancer randomly assigned to the intervention arm of Project Connect Online (PCO), a randomized controlled trial of an Internet-based intervention, and to examine relationships between website use variables and psychosocial outcomes.

METHODS

In the larger PCO trial, patients with breast cancer (n = 88) were randomly assigned to an intervention or a waiting-list control. This report pertains to the 46 women in the intervention arm, a 3-h workshop for creation of personal websites with a blog function to communicate with their interpersonal network and chronicle their breast cancer experience. Participants completed assessments at 1 and 6 months. Visitors to the websites (n = 66) completed an online questionnaire.

RESULTS

Reactions to website use were positive, although lack of time was a barrier for some. Women with advanced cancer were more likely to use their websites. Women found the websites useful for telling the story of their experience and expressing emotions. Positive word use was associated with heightened positive mood at 6 months; negative word use was associated with improved depressive symptoms. Visitors were most commonly female friends of participants who valued the websites as a way to connect emotionally with participants and receive information about their health.

CONCLUSIONS

Specific aspects of patients' blogs predicted improvements in psychosocial functioning. Personal websites can help women with breast cancer construct a narrative of their experience, express emotions, and receive the social support they need, particularly from friends and extended family.

Processing coping methods in expressive essays about stressful experiences: Predictors of health benefit

This study distinguished constructive (e.g. planning/problem-solving) and unconstructive (e.g. worry) processing in expressive essays and their impact on depressive symptoms, healthcare visits, and physical symptoms. Affect labeling, achievement orientation, and insight utilization were examined as mediators. Essays from 43 medical students were coded; mediators were identified through linguistic text analysis. Outcomes were assessed at baseline and 3 months. Constructive processing predicted declining depressive symptoms (β = −.33, p < .05) and healthcare visits (β = −.61, p < .01). Unconstructive processing predicted increasing healthcare visits (β = .42, p < .05). Higher affect labeling mediated the effect of constructive processing, and lower achievement orientation mediated the effect of unconstructive processing.

Understanding the utility of emotional approach coping: evidence from a laboratory stressor and daily life

BACKGROUND

Dispositional emotional approach coping (EAC) marks an adaptive tendency to process and express emotions. EAC's association with cognitions, affect, and intra- and interindividual characteristics that may account for its utility was examined in response to an acute stressor and in daily life.

DESIGN

This study included a laboratory stress task and ecological momentary assessment.

METHODS

Healthy undergraduate students (n = 124; mean age: 20; women: 56%) completed a laboratory component (baseline survey, speech stress task, pre- and posttask measures) and five subsequent days of surveys via palm pilot (six surveys/day).

RESULTS

Controlling for sex, neuroticism, and social support, greater EAC was associated with more positive cognitive appraisals, personal resources, and positive affect and less-negative affect during the lab stressor, and with more perceived control and positive affect in daily life. Significant EAC × sex interactions were found for poststressor affect: men with high EAC reported more positive affect and women with high EAC reported less negative affect.

CONCLUSIONS

Findings provide support that EAC's utility may be independent of intra- and interindividual characteristics, and that men and women may benefit from EAC in different ways in regards to affect. The proclivity to use EAC may come with a resiliency that protects against stress and promotes general well-being.