Coping With 'Scanxiety': Within-Person Processes in Lung Cancer

Background: Patients with early-stage lung cancer undergo potentially curative therapy, and continue to undergo regularly scheduled CT scans to determine if cancer has reappeared, spread, or stayed the same. This process can be fraught with anxiety, coined 'Scanxiety'. The present study examined how coping and scan-related anxiety fluctuate within-person before one's scan. Method: Twenty five individuals with lung cancer who had received curative intent treatment (M age = 62.33, [SD = 8.10], 96% women, 80% white) participated in the study, which had two parts. First, participants provided information about proactive coping and scan-related anxiety every 30 days. Next, a daily diary study was implemented for 7 consecutive days before their CT scan, as well as the day of their CT scan, where participants reported on their daily anticipatory coping and scan-related anxiety. The 25 participants provided 59 monthly and 146 daily surveys for analysis. Results: Multilevel models revealed significant main effects of monthly proactive coping on monthly scan-related anxiety, as well as daily anticipatory coping on daily scan-related anxiety. On months when participants decreased their use of proactive coping, they also reported decreases in scan-related anxiety for that month. On days when participants reported decreases in outcome fantasy and stagnant deliberation, they reported decreases in scan-related anxiety for that day. Finally, a significant interaction was found such that on days when middle-aged adults reported increases in problem analysis, they also reported increases in scan-related anxiety for that day. Conclusion: These findings are the first to characterize how participants' coping and scanxiety fluctuate in the months and days prior to their CT scans. Results indicated that focusing on the present may be more beneficial in reducing scan-related anxiety rather than thinking about the future. Future work should implement strategies to reduce scanxiety by focusing on the present among those with lung cancer.

Psychosocial Adaptation to Chronic Illness and Disability: An Updated and Expanded Conceptual Framework

The article revisits and updates an earlier model (Livneh, 2001) that examined the building blocks that constitute the dynamics of psychosocial adaptation to chronic illness and disability (CID). In the revised tripartite model, the author reconstructs and refines the earlier model based on recent theoretical formulations, clinical reviews and research findings. In the revised model, the author discusses three overarching components, namely, antecedents (causes of medical conditions, background variables), processes (the dynamically unfolding course of post-CID events), and outcomes (anticipated exit indicators that serve, as snapshot end products, to assess the individual’s experienced and reported quality of life following onset of CID). The article concludes with a brief review of the model’s practical and research implications.

Alcohol initiation among recently immigrated Hispanic adolescents: Roles of acculturation and sociocultural stress

There is a growing recognition for the need for research to explore the unique and interactive effects of acculturation and sociocultural stress on alcohol initiation. Building on this research agenda, the current study sought to explore the independent and interactive effects of acculturation (i.e., heritage and U.S. cultural practices and identification) and sociocultural stress (i.e., perceived discrimination, perceived context of reception, and bicultural stress) on alcohol initiation among recently immigrated Hispanic adolescents. Data were taken from a 6-wave longitudinal study with 302 recently immigrated Hispanic adolescents (53% boys; Mage = 14.51 years at baseline; range = 14-17 years) and their families. Discrete-time survival models indicated that none of the acculturation indicators directly predicted alcohol initiation. Sociocultural stress-and specifically, bicultural stress-predicted alcohol initiation. There were significant interactions between acculturation and sociocultural stress in predicting alcohol initiation. Further research considering multiple components of acculturation and sociocultural stressors is needed to broaden our understanding of the potential role of sociocultural processes in alcohol initiation among Hispanic youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Researcher Knows Best?

Missing from recent critiques of coping measurement are data demonstrating whether concepts used by researchers are understood by study participants. We asked 101 rheumatoid arthritis patients to complete a structured coping checklist and provide descriptions of their coping for each item checked. Trained researchers coded these open-ended descriptions using the original checklist categories. In general, patients' descriptions of their coping matched researcherderived definitions; however, patients were less likely to interpret cognitive and affective coping strategies in the manner intended by researchers. Patients' descriptions often crossed multiple categories, suggesting complex patterns not captured by most data analytic techniques. Whether they assess coping through structured measures or not, researchers must find ways to examine the multiple meanings and combinations of strategies that constitute the coping process. Keywords

Adaptive Tasks, Coping and Quality of Life of Chronically Ill Patients

This article is a report of a larger study on the relationship between adaptive tasks, coping and quality of life, taking Parkinson's disease and chronic fatigue syndrome (CFS) as examples. The concept of adaptive tasks or disease-related stressors testing the adaptive capacities of chronically ill patients ( N=134) was explored by applying the method of concept mapping. Results show that patients both with Parkinson's disease and with CFS generally refer to the same themes when asked for the adaptive tasks their disease brings about. However, the actual contents of these adaptive tasks differ as well as their impact on coping and quality of life. In the case of patients with Parkinson's disease, objective disease characteristics appear to be more important in predicting quality of life than in the case of patients with CFS, whose evaluation of adaptive tasks is predictive of quality of life.

A cognitive-existential intervention to improve existential and global quality of life in cancer patients: A pilot study

OBJECTIVE

We developed a specific cognitive-existential intervention to improve existential distress in nonmetastatic cancer patients. The present study reports the feasibility of implementing and evaluating this intervention, which involved 12 weekly sessions in both individual and group formats, and explores the efficacy of the intervention on existential and global quality of life (QoL) measures.

METHOD

Some 33 nonmetastatic cancer patients were randomized between the group intervention, the individual intervention, and the usual condition of care. Evaluation of the intervention on the existential and global QoL of patients was performed using the existential well-being subscale and the global scale of the McGill Quality of Life (MQoL) Questionnaire.

RESULTS

All participants agreed that their participation in the program helped them deal with their illness and their personal life. Some 88.9% of participants agreed that this program should be proposed for all cancer patients, and 94.5% agreed that this intervention helped them to reflect on the meaning of their life. At post-intervention, both existential and psychological QoL improved in the group intervention versus usual care (p = 0.086 and 0.077, respectively). At the three-month follow-up, global and psychological QoL improved in the individual intervention versus usual care (p = 0.056 and 0.047, respectively).

SIGNIFICANCE OF RESULTS

This pilot study confirms the relevance of the intervention and the feasibility of the recruitment and randomization processes. The data strongly suggest a potential efficacy of the intervention for existential and global quality of life, which will have to be confirmed in a larger study.

The association of metacognitive beliefs with emotional distress after diagnosis of cancer

OBJECTIVE

Emotional distress after a diagnosis of cancer is normal and, for most people, will diminish over time. However, a significant minority of patients with cancer experience persistent or recurrent symptoms of emotional distress for which they need help. A model developed in mental health, the self-regulatory executive function model (S-REF), specifies that maladaptive metacognitive beliefs and processes, including persistent worry, are key to understanding why such emotional problems persist. This cross-sectional study explored, for the first, time whether metacognitive beliefs were associated with emotional distress in a cancer population, and whether this relationship was mediated by worry, as predicted by the S-REF model.

METHOD

Two hundred twenty-nine participants within 3 months of diagnosis of, and before treatment for, primary breast or prostate cancer completed self-report questionnaires measuring anxiety, depression, posttraumatic stress disorder (PTSD) symptoms, metacognitive beliefs, worry, and illness perceptions.

RESULTS

Regression analysis showed that metacognitive beliefs were associated with symptoms of anxiety, depression, and PTSD, and explained additional variance in these outcomes after controlling for age, gender, and illness perceptions. Structural equation modeling was consistent with cross-sectional hypotheses derived from the theory that metacognitive beliefs cause and maintain distress both directly and indirectly by driving worry.

CONCLUSIONS

The findings provide promising first evidence that the S-REF model may be usefully applied in cancer. Further study is required to establish the predictive and clinical utility of these findings.

Coping specificity: the case of women coping with infertility treatments

Customizing the measurement of coping to a specific situation can answer some of the concerns regarding its measurement by checklist. A context-specific measure of coping with infertility was developed on the basis of theoretical principles of coping, interviews with women and providers, and existing findings. Data on the resulting Coping with Infertility questionnaire was collected from 652 Israeli women undergoing treatment and meta-strategies of coping were identified on the basis of a hierarchical structure of the coping subscales. About half of the women also filled in adjustment measures and findings showed differential associations of coping strategies to negative and positive indicators of psychological adjustment. Taking into account coping specificity can highlight strategies that function in ways that are unique to the context. This approach could be useful as a step in the assessment and understanding of coping with a specific health threat, which can guide further research and interventions designed to improve coping effectiveness.

Coping With Administrative Constraints by Quebec School Principals

The rapid pace of ongoing change in the Quebec education system has had an important impact on the complexity of the job and the workload of school principals. The present study examined the coping strategies used by school principals when facing administrative constraints. The Administrative Stress Index ASI ( N = 238) was used to identify and link the main stressors to the stressful encounters found on video for six principals out of the sample who accepted to be filmed during a working day. Coping strategies were identified in five sequences that met the necessary criteria for the explanatory qualitative analysis. The results show that the main sources of stress come from administrative constraints, and that the principals are not passive but rather try to cope by addressing the constraints they are faced with and by seeking information or support. Principals also have to cope with their emotions and show a lot of self-control. Overall, these findings point to the need for a better understanding of the relationship between stress and coping.

Coping with Negative Emotions: The Cognitive Strategies of HIV-infected Gay/Bisexual Men

While the managing of negative emotions has been identified as a central adaptive task for those living with chronic illnesses such as HIV/AIDS, little is known about the specific coping strategies used to achieve this task. The present study employed unstructured interviews to examine illnessspecific cognitive strategies used by an ethnically diverse sample of HIV-infected men who have sex with men (MSM) in their attempts to manage the negative emotions associated with the illness. Fourteen specific cognitive strategies were identified, many of which were specific to coping with chronic illness or HIV/AIDS. These strategies were categorized into four major conceptual categories: (1) distancing the threat of death; (2) reducing the sense of victimization; (3) gaining a sense of control; and (4) mentally preparing for emotional upset. The findings have implications for what coping assessments may be neglecting and may provide insights for therapeutic application.

Anticipating an altered appearance: Women undergoing chemotherapy treatment for breast cancer

Chemotherapy treatment for cancer can have a profound impact on appearance, and is often experienced as distressing. Few qualitative studies explore experiences of chemotherapy, and seldom focus on the process of anticipation and preparation for an altered appearance. We report findings from an interview study of 19 women which explored their expectations of chemotherapy-induced hair loss, their anticipated reactions to hair loss and how women intend to prepare for an altered appearance. The results demonstrate that women are active in anticipating hair loss and adopt a range of different strategies to manage their alopecia--even before it has occurred. Four key themes were identified: (a) anticipating hair loss, (b) coming to terms with the inevitability of hair loss, (c) becoming ready, and (d) taking control. We argue that this can be seen as a form of anticipatory coping, which involves affective and behavioural rehearsal so that women can feel more in control of their experience of the side effects of chemotherapy treatment for cancer. We suggest seeing these activities as a form of anticipatory coping, and understanding the psychological reasons why women engage in these activities, may help nursing professionals to better support women through this often traumatic time.

Tales of the unexpected: coping among female collegiate volleyball players

The purpose of this study was to examine patterns of appraisal, coping, and coping effectiveness in sport. Ten players from a collegiate female volleyball team were interviewed on two occasions, first in the week before a provincial final playoff tournament and in the week following the tournament. Data were transcribed verbatim and subjected to content and idiographic analyses. Athletes generally did not predict or anticipate the stressors they actually experienced during the tournament. Subjective appraisals of effective coping were associated with consistency between proactive and actual coping attempts. Reported effective coping was associated with the attainment of personal performance goals and use of cognitive, behavioral, and emotional coping strategies in the absence of behavioral avoidance. Reported ineffective and partially effective coping was associated with not attaining personal performance goals, and the use of cognitive coping strategies with behavioral avoidance. Finally, older, more experienced athletes reported they coped better than younger, less experienced athletes during the tournament.

Themes of effective coping in physical disability: an interview study of 26 persons who have learnt to live with their disability

The aim of this study was to gain a deeper understanding of effective coping in physical disability and/or chronic illness. Twenty-six well-adjusted adults with various disabilities were interviewed. The interviews focused on how they perceived they had managed to master problems encountered by their disability and their personal views about how one should act and think to manage a life with a disability. The protocols were content analysed according to grounded theory. Five categories were extracted--self-trust, problem-reducing actions, change of values, social trust and minimization. These categories clustered around two broader bipolar constructs--acknowledgement of reality vs. creation of hope and trust in oneself vs. trust in others. The different themes of coping complemented each other and tended to be used in different contexts in a flexible manner. Both the extracted categories and the core concepts have been extensively described in the coping literature, supporting their validity. The importance of understanding coping processes from the disabled's point of view is discussed.

Coping in context: the role of stress, social support, and personality in coping

Personality and social relationships play an important role in almost every aspect of stress and coping. Daily process methods are particularly useful in elucidating how these factors might influence both responses to and outcomes of stress. Our work has linked both dimensions of personality, particularly the Big Five, and aspects of social relationships, particularly social support, to the likelihood of engaging in certain coping strategies and the effectiveness or outcomes of these coping strategies. In addition, we have found the effect of personality on coping and stress outcomes to vary by the situational context in which stress occurs. We review findings from our recent daily process studies of stress, coping, and social support. Further, we discuss the costs and benefits of the daily process methodology for addressing these questions, highlighting the clinical utility of findings gleaned with the use of this approach. Finally, we discuss future directions and applications of daily process methods to the study of stress and coping.

Major stressors and their effects on the well-being of children with cancer

An in-depth exploratory study identified major stressors experienced by children diagnosed with cancer. Four themes were used to analyze data from a series of focus group discussions and individual interviews with children, parents, hospital professionals, and hospital teachers (N = 35). First, major stressful events were reported by the children, their parents, and hospital professionals. Second, the effects of major stressors on the well-being of the children, their families, school, and hospital personnel were determined. Third, the children reported the consequences of major stressors on their physical and emotional well-being. Fourth, the children's use of effective coping mechanisms was determined. The results revealed that the major stressors for children with cancer were treatment procedures (e.g., chemotherapy), loss of control, the hospital environment, relapses, and fear of dying. In addition, the children cited body image issues, ongoing lack of self-esteem, and issues relating to the preparation for transition back into real world situations (e.g., school).

Sinnfindung, Krankheitsverarbeitung und Lebensqualität von Tumorpatienten im perioperativen Verlauf

Zusammenfassung. Untersucht wird die Bedeutung individueller Sinnfindungsprozesse bei der Verarbeitung einer Tumorerkrankung im peri- und postoperativen Verlauf. Unter Sinnfindung wird die Verarbeitung der Bedrohung durch eine positive Deutung von Teilaspekten der Krankheitserfahrung verstanden. Ausgewertet wurden Daten von 32 Frauen und 52 Männern im Alter von 34 bis 86 Jahren (M = 63 Jahre, SD = 11 Jahre), die wegen eines Tumors im Gastrointestinaltrakt oder in der Lunge operiert wurden. Die Messzeitpunkte lagen drei Tage vor (t1), eine Woche (t2), einen Monat (t3) und ein halbes Jahr (t4) nach der Tumoroperation. Die Ausprägung von Sinnfindung war zu allen Messzeitpunkten hoch, und sie war bedeutsam höher als die von problembezogener und emotionsregulierender Krankheitsverarbeitung. Dennoch war ein signifikanter Anstieg von Sinnfindung während des Erhebungszeitraums zu beobachten. Sinnfindung korrelierte nicht bedeutsam mit emotionalem Wohlbefinden und gesundheitsbezogener Lebensqualität. Stattdessen stand der intra-individuelle Anstieg von Sinnfindung im Zeitraum von t1 zu t3 auch dann noch im Zusammenhang mit Depressivität und globaler gesundheitsbezogener Lebensqualität zu t4, wenn für die Ausgangswerte (t1) kontrolliert wurde. Entscheidender als die Ausprägung von Sinnfindung ist somit der intra-individuelle Zuwachs im perioperativen Krankheitsverarbeitungsprozess.

The measurement of coping responses: validity of the Billings and Moos Coping Checklist

OBJECTIVE

The primary aim of the study was to investigate the factor structure and psychometric properties of the modified Coping Checklist.

METHODS

Self-report questionnaires asking about coping responses and mental health were administered to 515 undergraduate university students and to 119 patients awaiting elective coronary artery bypass graft surgery. Confirmatory (CFA) and exploratory factor analyses (PCA) were used to summarize and describe coping responses.

RESULTS

CFA indicated that the subscale structure originally proposed for the Coping Checklist did not adequately fit the data. Subsequent PCA resulted in four factors: (1) Positive reappraisal; (2) Seeking support; (3) Avoidance; and (4) Information seeking. Internal consistencies ranged between .41 and .62 and 12-week test-retest reliability ranged between .59 and .71. Evidence for the concurrent validity of the solution generated by PCA was demonstrated by low to moderate correlations between the four factors identified and demographic and psychosocial measures.

CONCLUSION

Even with modifications to the Coping Checklist, it is recommended that researchers investigate alternative methods of assessing coping responses in health psychology settings.

Validation evidence for the French Canadian adaptation of the Multidimensional Fatigue Inventory as a measure of cancer-related fatigue

Cancer-related fatigue is the most reported symptom among patients with cancer. Researchers in the field of psychooncology have encouraged the development of short instruments, which allow for easier completion by clinical populations while still maintaining solid psychometric properties. The current study examined the validity and reliability of the French Canadian adaptation of the Multidimensional Fatigue Inventory (MFI) among women (n = 277) and men (n = 327) undergoing therapy for breast or prostate cancer, respectively. An exploratory factor analysis of the selected 15-item MFI yielded the following four factors: general/physical, mental, reduced motivation, and reduced activity. This was supported by a confirmatory factor analysis. The reliability, as evaluated by test-retest and Cronbach alpha internal consistency reliability coefficients of the French Canadian shortened MFI, was acceptable. In addition, the four factor-based scores correlated in a theoretically meaningful manner with existing measures of mood disturbance (Profile of Mood States and Hospital Anxiety and Depression Scale), cancer-related stressors (Inventory of Recent Life Experiences), coping with illness (Coping with Health Injuries and Problems Scale), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), and insomnia (Insomnia Severity Index), suggesting good construct, convergent, and concurrent criterion validity. Although further validation is recommended, the results for the French Canadian MFI in assessing cancer-related fatigue in both women and men undergoing cancer treatments showed good psychometric qualities.

The psycho-social impact of infertility on young male cancer survivors: a qualitative investigation

Intensive treatment regimes that are known to have a potential risk of infertility sometimes have to be given to boys who have aggressive malignant disease. Long-term care must therefore include further discussion of these patients' impaired fertility. This study describes the results of a series of semi-structured interviews with 15 young male cancer survivors regarding their experience of receiving feedback on their probable fertility status. All the interviews were conducted by a psychologist formerly uninvolved with their treatment. The interviews were analysed qualitatively using a grounded theory approach. The findings of the study are organised under four headings: (a) Emotional reaction to news of probable infertility. (b) Coping style adopted. (c) Response to the offer of semen analysis. (d) Implications for clinical practice.The results of this thematic analysis are compared to the wider research literature in oncology and health psychology.

Coping with the challenge of transition in older adolescents with epilepsy

Chronic illnesses, such as epilepsy, have been shown to have detrimental effects on both psychological adjustment and coping behaviour. Using the process model of coping, these effects were investigated in a patient group of 36, 16-21 year olds with epilepsy and a control group of 31 of their peers. Participants completed a postal questionnaire containing measures of psychological adjustment (self-esteem, affect, self-efficacy) and an adolescent coping questionnaire. Comparison of the two groups showed that the patient group exhibited significantly more non-productive coping than the control group. The control group exhibited significantly more problem solving coping and displayed significantly more problem solving bias than the patient group. No significant differences were found between the patient and control group on measures of psychological adjustment. However, psychological adjustment was found to be associated with coping response in the patient but not the control group.

Developing interventions for chronically ill patients: is coping a helpful concept?

In this review, the role of coping in the development of psychosocial interventions for chronically ill patients is discussed. After summarizing the theoretical issues involved in the translation of the coping concept into an intervention, a review is undertaken of 35 studies concerned with the impact of interventions aimed at improving coping on patients' quality of life. These studies concern seven different chronic disease types (AIDS, asthma, cancer, cardiovascular diseases, chronic pain, diabetes, and rheumatoid arthritis) and show explicit consideration of attempts to manage illness in terms of coping to be rare. Many studies nevertheless address the equivalent of coping, namely behaviors and/or cognitions intended to deal with an illness situation appraised as stressful. The results of these studies are encouraging, although largely limited to the improvement of one or two particular coping strategies and problem-focused strategies in particular. It is argued that in order to expand on these initially positive findings, greater and more explicit consideration should be given to the potential of the coping concept for intervention with the chronically ill. The appraisal of stressful situations, the use of coping resources, and the strategic application of particular coping strategies should, for example, be given more careful consideration.

Adjustment to cancer - coping or personal transition?

The term 'adjustment' is widely used within the psycho-oncology literature and, although it is a topic of central importance to the lived experience of people with cancer, the psychological mechanisms of adjustment have rarely been described. Rather than regarding it as the absence of psychopathology or the end-point of coping with the global threat of cancer, adjustment refers to the psychological processes that occur over time as the individual, and those in their social world, manage, learn from and adapt to the multitude of changes which have been precipitated by the illness and its treatment. However, these changes are not always for the worse: sometimes they precipitate 'healthy personal growth' in a number of areas. It is only from explicit theories of adjustment that progress can be made in understanding how and why psychological disorders so frequently develop in cancer and what steps may be taken to prevent them. This paper combines the complementary assets of coping theory and social-cognitive theory and proposes the Social-Cognitive Transition (SCT) model of adjustment, a clinical model which also accounts for the frequent reports of healthy personal growth associated with cancer.

Never the Twain shall meet? Closing the gap between coping research and clinical intervention research

Two distinct literatures have contributed to a tremendous growth of interest in coping. The 1st consists of descriptive studies that have used coping checklists. This literature is in crisis because of its failure to yield substantive findings concerning the role of coping in adaptation that cannot be dismissed as truisms, trivia, or the product of a confounding of stress, coping, and distress. The 2nd literature concerns interventions to improve adaptation by enhancing coping. It provides evidence of the efficacy of intervention but provides little understanding of crucial ingredients, mechanisms of change, or barriers to maintaining gains. Both literatures would benefit from cross-fertilization. Process studies of interventions designed to improve coping provide an alternative to fruitless and potentially misleading correlational studies using checklists. Such studies might also aid in understanding and refining intervention strategies.

A systems model for adaptation to somatic distress among cancer survivors

Applied coping research has generally failed to fulfill its goal of providing an empirical basis for clinical interventions, and research on coping with cancer is no exception. This can be attributed in large measure to the wide gap between coping theory and coping research. Theories of stress and adaptation are complex systems formulations that present conceptual and methodological challenges and thus make testing comprehensive models difficult. The present paper reviews arguments for a microanalytic strategy through which researchers can increase coverage of relevant variables from broad systems models of stress and coping by concentrating their resources on selected, high-frequency, high-stress problems. The utility of this approach for formulating problem-specific systems models is illustrated using the example of coping with somatic distress among cancer survivors.