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Czamanski-Cohen J, Weihs KL. The role of emotion processing in art therapy (REPAT) intervention protocol. Front Psychol 2023; 14:1208901. [PMID: 37457095 PMCID: PMC10343444 DOI: 10.3389/fpsyg.2023.1208901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Psychological and physical health are known to improve with emotion processing, which is becoming aware of bodily sensations, accepting them as information that can be translated into emotion concepts and expressing them symbolically and linguistically as emotions. Art therapy utilizes the visual arts for processing emotions to facilitate self-expression and communication with the goal of improving psychological wellbeing. The mental health of individuals coping with and recovering from cancer is known to benefit from art therapy. The purpose of this paper is to describe the development of the role of emotion processing in art therapy (REPAT) intervention, which is an 8 week, one and a half hour art therapy intervention created to target emotion processing as a primary mechanism of change, through which art therapy has the potential to reduce symptoms (i.e., depression, pain and fatigue) of women coping with breast cancer. To obtain this goal we used template for intervention description and replication (TIDieR) and GUIDance for the rEporting of intervention Development (GUIDED) guidelines for intervention development description, with the goal of ensuring successful implementation for clinical and research use.
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Affiliation(s)
- Johanna Czamanski-Cohen
- The School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Karen L. Weihs
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
- Cancer Prevention and Control Program, University of Arizona Comprehensive Cancer Center, Tucson, AZ, United States
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2
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Levy-Gigi E, Shamay-Tsoory S. Affect labeling: The role of timing and intensity. PLoS One 2022; 17:e0279303. [PMID: 36580454 PMCID: PMC9799301 DOI: 10.1371/journal.pone.0279303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 12/05/2022] [Indexed: 12/30/2022] Open
Abstract
A growing number of studies have shown that labeling negative feelings can down-regulate distress. The present study aimed to test the effectiveness of affect labeling while manipulating two factors known to influence the emotion regulation process, namely timing, and emotional intensity. In Experiment 1, sixty-three participants completed a performance-based affect labeling paradigm in which they had to choose between two labels that best describe their feeling. Participants were randomly assigned to one of three experimental conditions: (1) Simultaneous labeling- the labeling occurs while watching the aversive picture. (2) Subsequent labeling- the labeling occurs immediately after watching the aversive picture. (3) Delayed labeling- the labeling occurs 10 seconds after watching the aversive picture. We found that affect labeling efficiently down-regulated distress independent of the labeling timing. In Experiment 2, seventy-nine participants utilized simultaneous labeling for aversive pictures with low and high intensity. We revealed that while affect labeling reduces distress in high-intensity aversive conditions, it increases distress in low-intensity conditions. The results question the standard advice, which calls to count to 10 before you speak in highly aversive states. In addition, it suggests that affect labeling can be beneficial in high-intensity conditions. However, it should be used with caution in low-intensity conditions.
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Affiliation(s)
- Einat Levy-Gigi
- Faculty of Education Bar-Ilan University, Ramat-Gan, Israel
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
- * E-mail:
| | - Simone Shamay-Tsoory
- Department of Psychology, University of Haifa, Haifa, Mount Carmel, Haifa, Israel
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3
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Stanley BL, Zanin AC, Avalos BL, Tracy SJ, Town S. Collective Emotion During Collective Trauma: A Metaphor Analysis of the COVID-19 Pandemic. QUALITATIVE HEALTH RESEARCH 2021; 31:1890-1903. [PMID: 33980096 DOI: 10.1177/10497323211011589] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study provides insight into lived experiences of the COVID-19 pandemic in the United States. Participant metaphors of the pandemic were collected by conducting in-depth semi-structured interviews (N = 44). Participants were asked to compare the pandemic with an animal and with a color, and to provide contextual sensemaking about their metaphors. A metaphor analysis revealed four convergent mental models of participants' pandemic experiences (i.e., uncertainty, danger, grotesque, and misery) as well as four primary emotions associated with those mental models (i.e., grief, disgust, anger, and fear). Through metaphor, participants were able to articulate deeply felt, implicit emotions about their pandemic experiences that were otherwise obscured and undiscussable. Theoretical and practical implications of these collective mental models and associated collective emotions related to the unprecedented collective trauma of the COVID-19 pandemic are discussed.
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Affiliation(s)
| | | | | | | | - Sophia Town
- Fordham University, New York City, New York, USA
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Hoyt MA, Darabos K, Llave K. Emotional processing writing and physiological stress responses: understanding constructive and unconstructive processes. Cogn Emot 2021; 35:1187-1194. [PMID: 34011237 DOI: 10.1080/02699931.2021.1929083] [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] [Indexed: 10/21/2022]
Abstract
Writing about emotions related to a life stressor is thought to promote coping via emotional processing. However, all styles of emotional processing may not be beneficial to managing stress. Such styles can include constructive (planning/problem-solving, meaning-making) and unconstructive (rumination, worry) forms. This study utilised a randomised experimental design to examine the physiological impact (as indexed by heart rate variability, salivary cortisol reactivity and recovery) of expressive writing with guidance to promote constructive and discourage unconstructive styles (EP+) versus expressive writing with no guidance (EP). Participants (N = 151) engaged in three sessions of expressive writing anchored to a self-nominated stressor over three days. Stress reactivity was measured two weeks later in response to a stress recall task. There was no effect of group on cortisol reactivity, cortisol recovery, or HRV reactivity. However, there was a significant interaction of group and subjective stressfulness of the nominated stressor was observed, such that EP+ was associated with greater cortisol recovery. Those with more taxing stressors may be better equipped to process emotions with guidance on emotional processing styles.
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Affiliation(s)
- Michael A Hoyt
- Department of Population Health and Disease Prevention, University of California Irvine, Irvine, CA, USA
| | - Katie Darabos
- Behavioral Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Karen Llave
- Department of Population Health and Disease Prevention, University of California Irvine, Irvine, CA, USA
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Habermas T, Delarue I, Eiswirth P, Glanz S, Krämer C, Landertinger A, Krainhöfner M, Batista J, Gonçalves MM. Differences Between Subclinical Ruminators and Reflectors in Narrating Autobiographical Memories: Innovative Moments and Autobiographical Reasoning. Front Psychol 2021; 12:624644. [PMID: 33763000 PMCID: PMC7982801 DOI: 10.3389/fpsyg.2021.624644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
Reasoning may help solving problems and understanding personal experiences. Ruminative reasoning, however, is inconclusive, repetitive, and usually regards negative thoughts. We asked how reasoning as manifested in oral autobiographical narratives might differ when it is ruminative versus when it is adaptive by comparing two constructs from the fields of psychotherapy research and narrative research that are potentially beneficial: innovative moments (IMs) and autobiographical reasoning (AR). IMs captures statements in that elaborate on changes regarding an earlier personal previous problem of the narrator, and AR capture the connecting of past events with other parts of the narrator’s life or enduring aspects of the narrator. A total of N = 94 university students had been selected from 492 students to differ maximally on trait rumination and trait adaptive reflection, and were grouped as ruminators (N = 38), reflectors (N = 37), and a group with little ruminative and reflective tendencies (“unconcerned,” N = 19). Participants narrated three negative personal experiences (disappointing oneself, harming someone, and being rejected) and two self-related experiences of more mixed valence (turning point and lesson learnt). Reflectors used more IMs and more negative than positive autobiographical arguments (AAs), but not more overall AAs than ruminators. Group differences were not moderated by the valence of memories, and groups did not differ in the positive effect of narrating on mood. Trait depression/anxiety was predicted negatively by IMs and positively by AAs. Thus, IMs are typical for reflectors but not ruminators, whereas the construct of AR appears to capture reasoning processes irrespective of their ruminative versus adaptive uses.
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Affiliation(s)
- Tilmann Habermas
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Iris Delarue
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Pia Eiswirth
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Sarah Glanz
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Christin Krämer
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Axel Landertinger
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | | | - João Batista
- Psychology Research Centre, School of Psychology, Universidade de Minho, Braga, Portugal
| | - Miguel M Gonçalves
- Psychology Research Centre, School of Psychology, Universidade de Minho, Braga, Portugal
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6
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Paquin V, Bick J, Lipschutz R, Elgbeili G, Laplante DP, Biekman B, Brunet A, King S, Olson D. Unexpected effects of expressive writing on post-disaster distress in the Hurricane Harvey Study: a randomized controlled trial in perinatal women. Psychol Med 2021; 52:1-9. [PMID: 33706830 DOI: 10.1017/s003329172100074x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Expressive writing requires journaling stressor-related thoughts and feelings over four daily sessions of 15 min. Thirty years of research have popularized expressive writing as a brief intervention for fostering trauma-related resilience; however, its ability to surpass placebo remains unclear. This study aimed to determine the efficacy of expressive writing for improving post-traumatic stress symptoms in perinatal women who were living in the Houston area during major flooding caused by Hurricane Harvey. METHODS A total of 1090 women were randomly allocated (1:1:1) to expressive writing, neutral writing or no writing. Interventions were internet-based. Online questionnaires were completed before randomization and at 2 months post-intervention. The primary outcome was post-traumatic stress symptoms, measured with the Impact of Event Scale-Revised; secondary outcomes were affective symptoms, measured with the 40-item Inventory of Depression and Anxiety Scales. Feelings throughout the intervention were reported daily using tailored questionnaires. RESULTS In intention-to-treat analyses, no post-treatment between-group differences were found on the primary and secondary outcomes. Per-protocol analyses yielded similar results. A number of putative moderators were tested, but none interacted with expressive writing. Expressive writing produced greater feelings of anxiety and sadness during the intervention compared to neutral writing; further, overall experiences from the intervention mediated associations between expressive writing and greater post-traumatic stress at 2 months post-intervention. CONCLUSIONS Among disaster-stricken perinatal women, expressive writing was ineffective in reducing levels of post-traumatic stress, and may have exacerbated these symptoms in some.
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Affiliation(s)
- Vincent Paquin
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
| | - Johanna Bick
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Guillaume Elgbeili
- Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
| | - David P Laplante
- Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
- Center for Child Development and Mental Health, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Brian Biekman
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Alain Brunet
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
| | - Suzanne King
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
| | - David Olson
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, AB, Canada
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Wang Y, Liu L, Ding N, Li H, Wen D. The Mediating Role of Stress Perception in Pathways Linking Achievement Goal Orientation and Depression in Chinese Medical Students. Front Psychol 2021; 12:614787. [PMID: 33679530 PMCID: PMC7934623 DOI: 10.3389/fpsyg.2021.614787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022] Open
Abstract
Mental health problems are frequent obstacles in medical students’ careers as doctors. Given that previous studies overlook the mediation of stress perception, the current study expanded previous goal orientation researches by addressing an unexplored mechanism. This study aims to examine the mediational roles of stress perception (perceived stressors and stress-related cognition) on the relationship between achievement goal orientation and depression in medical students. A total of 1,015 Chinese 2-year medical students completed a multi-section questionnaire. Hypotheses were examined by structural equation modeling. The findings suggest that performance-avoidance goal orientation and perceived stressors both demonstrated direct facilitative effects on depression, whereas stress-related cognition demonstrated direct obstructive effects on depression. Both perceived stressors and stress-related cognition mediated the relationship between achievement goal orientation and depression. The findings spark a new perspective on motivational intervention that assist students in adopting mastery-approaching strategy as well as ways of coping with stressful academic situations. Identifying students with achievement goal orientation and providing them with the appropriate supportive services may help them to manage stress and mitigate or prevent depression.
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Affiliation(s)
- Yan Wang
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Luping Liu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Ning Ding
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Deliang Wen
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
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Czamanski-Cohen J, Wiley J, Weihs KL. Protocol for the REPAT study: role of emotional processing in art therapy for breast cancer palliative care patients. BMJ Open 2020; 10:e037521. [PMID: 33444178 PMCID: PMC7678396 DOI: 10.1136/bmjopen-2020-037521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Patients with breast cancer (BC) cope with depression which is linked to functional limitations in survivorship and to physical symptoms. Pain and fatigue are prominent symptoms that affect the well-being of cancer survivors. Emotional processing has been associated with improved physical and psychological health in survivors. Art therapy is a form of psychotherapy that involves the use of visual art-making for expression and communication. It encourages emotional processing and has been linked to symptom reduction in patients with cancer. This protocol is designed to examine two mechanistic changes: emotional processing (awareness, expression and acceptance) and cholinergic anti-inflammatory processes (heart rate variability and cytokine expression) through which an art therapy intervention may reduce depression, pain and fatigue. In addition, we will examine ethnocultural differences in the effect of art therapy in women from different ethnocultural backgrounds. METHODS AND ANALYSIS A randomised controlled study with careful controls will randomise 240 patient with BC (50% Jewish and 50% Arab) to an 8-week group art therapy intervention or an 8-week Mandala colouring comparison group. This design will test the mechanisms of art therapy on the targeted outcomes beyond the effects of time with a group, focus on a task and engagement with art materials. We will examine two potential mechanisms: emotional processing and cholinergic anti-inflammatory processes; of the intervention effects on depression, pain and fatigue and compare these effects in Arab versus Jewish women. ETHICS AND DISSEMINATION Participants will sign informed consent before participation and will be informed that they can leave the study at any point in time without effect on their medical treatment. The Helsinki committees of each participating hospital have approved the study. Data collected in this study will be published in peer-review journals, and we will use the platform of the study website (http://repat.haifa.ac.il/en/) for further dissemination to the general public. TRIAL REGISTRATION NUMBER The study is registered in ClinicalTrials.gov: NCT03377816; Pre-results.
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Affiliation(s)
- Johanna Czamanski-Cohen
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
| | - Joshua Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - K L Weihs
- The Department of Psychiatry College of Medicine, University of Arizona, Tucson, Arizona, USA
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Macía P, Gorbeña S, Barranco M, Alonso E, Iraurgi I. Role of resilience and emotional control in relation to mental health in people with cancer. J Health Psychol 2020; 27:211-222. [PMID: 32783467 PMCID: PMC8739566 DOI: 10.1177/1359105320946358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study explored the relationship between emotional control, resilience, and mental health in cancer. Patients with cancer were recruited (n = 170). Courtauld Scale of Emotional Control, Connor-Davidson Resilience Scale, and the General Health Questionnaire were selected. Assuming the absence of interaction among the variables, they were analyzed separately. Four groups resulted, finding statistically significant differences (F(4, 165) = 18.03; p < 0.001). High resilience and low emotional control seem to be protective attributes, and high emotional control has demonstrated to be a risk factor for mental health. Considering differences in cancer-related psychological variables could derive in personalized psychotherapeutic interventions.
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Affiliation(s)
- Patricia Macía
- Department of Personality, Evaluation and Psychological Treatments, Faculty of Psychology and Education, University of Deusto, Bilbao (Biscay), Spain
| | - Susana Gorbeña
- Department of Personality, Evaluation and Psychological Treatments, Faculty of Psychology and Education, University of Deusto, Bilbao (Biscay), Spain
| | - Mercedes Barranco
- Spanish Association Against Cancer, Provincial Office of Biscay, Spain
| | - Estibaliz Alonso
- Spanish Association Against Cancer, Provincial Office of Biscay, Spain
| | - Ioseba Iraurgi
- Department of Personality, Evaluation and Psychological Treatments, Faculty of Psychology and Education, University of Deusto, Bilbao (Biscay), Spain
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Hoyt MA, Wang AWT, Boggero IA, Eisenlohr-Moul TA, Stanton AL, Segerstrom SC. Emotional approach coping in older adults as predictor of physical and mental health. Psychol Aging 2020; 35:591-603. [PMID: 32271069 PMCID: PMC8199838 DOI: 10.1037/pag0000463] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Emotional approach coping involves active attempts at emotional expression and processing in response to stressful circumstances. This study tested whether dispositional emotional approach coping processes predict changes in physical and mental health in community-dwelling older adults, particularly within the context of higher perceived stress. To test this, older adults (N = 150) completed assessments of emotional expression and emotional processing at study entry. They also completed measures of perceived stress, depressive symptoms, and ill-health (a composite of subjective and objective physical health indicators, which included blood draw for collection of biomarkers), every 6 months over 4.5 years. Emotional processing and emotional expression were not related significantly to ill-health at study entry. However, emotional processing (but not emotional expression) significantly predicted changes in ill-health. At higher levels of emotional processing, ill-health remained low and stable; at lower levels of emotional processing, ill-health increased over time. However, when perceived stress was high, higher emotional processing and emotional expression were related to lower depressive symptoms at study entry, but higher emotional processing was associated with increasing depressive symptoms over time. Emotional approach coping processes evidence prospective relations with health outcomes, which are partially conditioned by stress perceptions. Emotional processing appears to have a protective impact against declining physical health. Predictive relationships for depressive symptoms are more complex. Older adults with chronically high perceived stress might benefit from interventions that target emotion-regulating coping processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Darabos K, Hoyt MA. Emotional Processing Coping Methods and Biomarkers of Stress in Young Adult Testicular Cancer Survivors. J Adolesc Young Adult Oncol 2020; 9:426-430. [PMID: 31971856 DOI: 10.1089/jayao.2019.0116] [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] [Indexed: 11/13/2022] Open
Abstract
Coping through emotional processing (EP) with cancer-related circumstances can take several forms, including methods thought to be constructive (e.g., planning, meaning making) and unconstructive (e.g., rumination). These forms can have differential relationships with experiences of stress. Associations of coping through constructive and unconstructive EP in expressive writing with salivary stress biomarkers were examined among young adult testicular cancer survivors. Constructive processing was significantly associated with less overall daily cortisol output and smaller salivary alpha-amylase awakening response; unconstructive processing was also associated with lower daily cortisol output. These preliminary results from this exploratory study inform future research associating emotion-regulation coping and biological stress reactivity.
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Affiliation(s)
- Katie Darabos
- Behavioral Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael A Hoyt
- Department of Population Health and Disease Prevention, Chao Family Comprehensive Cancer Center and the Interdisciplinary Institute for Salivary Bioscience Research, University of California Irvine, Irvine, California, USA
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Thoele DG, Gunalp C, Baran D, Harris J, Moss D, Donovan R, Li Y, Getz MA. Health Care Practitioners and Families Writing Together: The Three-Minute Mental Makeover. Perm J 2019; 24:19.056. [PMID: 31852046 DOI: 10.7812/tpp/19.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Expressive writing, the process of self-expression through writing, appears to have beneficial effects. Our hospital's narrative medicine group developed an expressive writing tool, the Three-Minute Mental Makeover (3MMM). OBJECTIVE To evaluate the effectiveness of the 3MMM to reduce stress and optimize communication between health care practitioners and their patients/families. METHODS Patients and families were recruited from a Chicago-area children's hospital from December 2016 through July 2017, from the neonatal intensive care unit, pediatric intensive care unit, inpatient pediatric unit, and outpatient pediatric clinics. Health care practitioners included a pediatric cardiologist, pediatric residents, child development specialists, and pediatric nurses. Practitioner and patient family participants completed prestudy and poststudy surveys to assess perceived stress and communication levels. Using a standardized script, practitioners led the 3MMM activity, writing concurrently with patients/families. Participants then shared their responses. Presurvey and postsurvey data were compared using nonparametric tests. RESULTS Eight practitioners led 96 patient/family members in 3MMM activities and study surveys. At baseline, all patients, family members, and practitioners reported experiencing 1 or more symptoms of stress. After participating in the 3MMM, patients/family members and practitioners reported reduced stress compared with baseline (p < 0.001). A significant improvement in communication was reported by practitioners (p < 0.001). Eighty-eight percent of patients/families reported that the 3MMM activity was helpful, even though only 35% had used writing or journaling in the past. CONCLUSION The 3MMM is a short writing exercise that reduces stress for practitioners, patients, and families. Future studies may help determine long-term effects of the 3MMM.
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Affiliation(s)
| | | | | | | | | | | | - Yi Li
- Advocate Center for Pediatric Research, Advocate Children's Hospital, Oak Lawn, IL
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Alpert JM, Morris BB, Thomson MD, Matin K, Sabo RT, Brown RF. Patient access to clinical notes in oncology: A mixed method analysis of oncologists' attitudes and linguistic characteristics towards notes. PATIENT EDUCATION AND COUNSELING 2019; 102:1917-1924. [PMID: 31109771 PMCID: PMC6716990 DOI: 10.1016/j.pec.2019.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Providers have expressed concern about patient access to clinical notes. There is the possibility that providers may linguistically censor notes knowing that patients have access. PURPOSE Qualitative interviews and a pre- and post- linguistic analysis of the implementation of OpenNotes was performed to determine whether oncologists changed the content and style of their notes. METHODS Mixed methods were utilized, including 13 semi-structured interviews with oncologists and random effects modeling of over 500 clinical notes. The Linguistic Inquiry and Word Count program was used to evaluate notes for emotions, thinking styles, and social concerns. RESULTS No significant differences from pre- and post-implementation of OpenNotes was found. Thematic analysis revealed that oncologists were concerned that changing their notes would negatively impact multidisciplinary communication. However, oncologists acknowledged that notes could be more patient-friendly and may stimulate patient-provider communication. CONCLUSIONS Although oncologists were aware that patients could have access, they felt strongly about not changing the content of notes. A comparison between pre- and post-implementation confirmed this view and found that notes did not change. PRACTICE IMPLICATIONS Patient access to oncologist's notes may serve as an opportunity to reinforce important aspects of the consultation.
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Affiliation(s)
| | - Bonny B Morris
- Virginia Commonwealth University, Health Behavior and Policy
| | - Maria D Thomson
- Virginia Commonwealth University, Health Behavior and Policy
| | - Khalid Matin
- Virginia Commonwealth University, Hematology/Oncology
| | - Roy T Sabo
- Virginia Commonwealth University, Biostatistics
| | - Richard F Brown
- Virginia Commonwealth University, Health Behavior and Policy
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Cova F, Garcia F, Oyanadel C, Villagran L, Páez D, Inostroza C. Adaptive Reflection on Negative Emotional Experiences: Convergences and Divergence Between the Processing-Mode Theory and the Theory of Self-Distancing Reflection. Front Psychol 2019; 10:1943. [PMID: 31551854 PMCID: PMC6734160 DOI: 10.3389/fpsyg.2019.01943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/07/2019] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Félix Cova
- Departamento de Psicología, Universidad de Concepción, Concepción, Chile
| | - Felipe Garcia
- Facultad de Ciencias Sociales y Comunicación, Universidad Santo Tomas, Concepción, Chile
| | - Cristian Oyanadel
- Departamento de Psicología, Universidad de Concepción, Concepción, Chile
| | - Loreto Villagran
- Departamento de Psicología, Universidad de Concepción, Concepción, Chile
| | - Dario Páez
- Facultad de Psicología, Universidad del País Vasco, Leioa, Spain
- Facultad de Educación y Ciencias Sociales, Universidad Andres Bello, Concepción, Chile
| | - Carolina Inostroza
- Departamento de Psicología, Universidad de Concepción, Concepción, Chile
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
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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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Devereux PG, Heffner KL, Doane MJ, Gosser B, Nolan M. Identifying attentional deployment tactics in older adults' written narratives about emotionally upsetting events. J Health Psychol 2015; 21:2247-58. [PMID: 25776133 DOI: 10.1177/1359105315573444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Essays about distressing events written by 58 older adults on three occasions (n = 174) were coded to identify how older adults responded when confronting an emotionally upsetting event. Participants limited the experience of negative emotion by transitioning from negative to positive aspects of the event within a writing session, and across sessions, switched writing topics and moved from writing about past events to current problems. The use of attentional deployment tactics was associated with lower negative affect. This study confirms results found in quantitative studies and uncovers new processes that promote emotion regulation.
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