Finding positive meaning and its association with natural killer cell cytotoxicity among participants in a bereavement-related disclosure intervention

Bidirectional associations between meaning in life and the health, emotional ill-being and daily life functioning outcomes among older adults

OBJECTIVE

Meaning and purpose in life are recognised health determinants. Evidence on the factors contributing to the experience of meaning and purpose in life is limited. The bidirectional associations between the experience of meaning in life and physical health, emotional ill-being and daily life functioning from a 6-year perspective are examined.

METHODS AND MEASURES

Longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) were analysed using generalised estimating equations. The sample included 16,361 middle-aged and older adults from 13 countries.

RESULTS

Living a meaningful life was found to be associated with subsequent reduced risks of depression, loneliness, limitations in activities of daily living, and heart attack (at the 6-year follow-up). It was also found that prior experience of depression, loneliness and limited activities of daily living were associated with subsequent reduced sense of meaningful life. These associations were independent of demographics, socioeconomic status, personality, prior history of diseases and lifestyle. The sensitivity analyses provided evidence for the robustness of these associations.

CONCLUSIONS

Evidence for health practitioners and policymakers on factors that may hamper the development and maintenance of meaningful life as well as on the role of sense of meaning in life for healthy aging was presented.

Validation of the Portuguese version of the Integration of Stressful Life Experiences Scale (ISLES) in a sample of bereaved individuals

The Integration of Stressful Life Experiences Scale (ISLES) evaluates the ability to integrate stressful experiences into one's meaning system. The present study developed and validated a version of this scale for a bereaved Portuguese-speaking population, utilizing a sample of 242 adults who had lost a significant other to diverse causes of death. The sample was predominantly female, educated, married, or in consensual unions, and actively employed. Confirmatory factor analysis revealed a two-factor structure, consisting of 13 items, showing adequate local and global goodness-of-fit and supporting the proposed original structure. Convergent evidence based on internal structure was found for the two dimensions (Comprehensibility and Footing in the World). Regarding reliability, Cronbach's alpha and McDonald's omega computed for each factor showed good internal consistency and the average inter-item correlation was considered satisfactory. This psychometric support for ISLES underscores its relevance in enhancing the knowledge of meaning-making processes in the Portuguese context.

The relationship between meaning in life and apathy in people with Parkinson's disease: a cross-sectional analysis

BACKGROUND

Apathy remains a common and problematic neuropsychiatric feature associated with Parkinson's disease resulting in reductions in health-related quality of life, and effective treatments remain elusive. Meaning in life (MIL) has been implicated in a variety of positive health outcomes, and this study assesses the relationship between apathy and MIL while hoping to identify a potential new interventional target.

METHODS

A cross-sectional sample of 237 PwPD completed surveys to evaluate MIL and a variety of non-motor symptoms (NMS), and a hierarchical regression analysis was conducted to evaluate relationships of interest.

RESULTS

Correlational analysis indicated the presence of meaning in life was statistically negatively and moderately to strongly correlated with apathy (r = - 0.60, p < .001). Hierarchical regression analysis results showed that presence of meaning in life explained a total of 48% of variance in apathy. More specifically, the presence of meaning in life (β = - 0.43, p < .001) was associated with apathy after controlling for sociodemographic and other potentially confounding variables.

CONCLUSIONS

This study demonstrates the significant negative relationship between MIL and apathy. Considering the lack of effective treatments for apathy, which is one of the most disabling symptoms affecting PwPD, identifying a potential target for intervention is exciting. MIL has the potential to offer clinicians a novel intervention to provide a much-needed treatment option to improve both apathy and HRQoL.

A pilot study on the impacts of lung-strengthening Qigong on wellbeing

BACKGROUND

Qigong embraces a range of self-care exercises originating from China. Lung-Strengthening Qigong (LSQ) is a specific technique for maintaining and improving physical and mental wellbeing.

METHODS

We recruited 170 practitioners and 42 non-practitioner/control samples to investigate the impacts of LSQ practice on body, mind, thoughts, and feelings. This is a pilot study pursued to plan for an adequately powered, non-clinical randomized controlled trials (RCT) on overall wellbeing and health and to evaluate the adequacy of delivering the physical activity intervention with fidelity. Self-evaluation-based data collection schemes were developed by regularly requesting completion of a questionnaire from both practitioner and control group, and an online diary and end of study survey (EOS) completion only from the practitioners. Diverse types of analyses were conducted, including statistical tests, machine learning, and qualitative thematic models.

RESULTS

We evaluated all different data resources together and observed that (a)the impacts are diverse, including improvements in physical (e.g., elevated sleep quality, physical energy, reduced fatigue), mental (e.g., increased positivity, reduced stress), and relational (e.g., enhanced connections to self and nature) wellbeing, which were not observed in control group; (b)measured by the level-of-effectiveness, four distinct clusters were identified, from no-effect to a high-level of effect; (c)a majority (84 %) of the LSQ practitioners experienced an improvement in wellbeing; (d)qualitative and quantitative analyses of the diary entries, questionnaires, and EOS were all found to be consistent, (e)majority of the positively impacted practitioners had no or some little prior experience with LSQ.

CONCLUSIONS

Novel features of this study include (i)an increased sample size vis-à-vis other related studies; (ii)provision of weekly live-streamed LSQ sessions; (iii)integration of quantitative and qualitative type of analyses. The pilot study indicated that the proportion of practitioners who continued to engage in completing the regular-interval questionnaires over time was higher for practitioners compared to the control group. The engagement of practitioners may have been sustained by participation in the regular live LSQ sessions. To fully understand the impacts of LSQ on clinical/physiological outcomes, especially for specific patient groups, more objective biomarkers (e.g. respiratory rate, heart rate variation) could be tracked in future studies.

Psychoneuroimmunology in the time of COVID-19: Why neuro-immune interactions matter for mental and physical health

The brain and immune system are intricately connected, and perturbations in one system have direct effects on the other. This review focuses on these dynamic psychoneuroimmune interactions and their implications for mental and physical health in the context of the COVID-19 pandemic. In particular, we describe how psychological states influence antiviral immunity and the vaccine response, and how immune changes triggered by COVID (either via infection with SARS-CoV-2 or associated stressors) can influence the brain with effects on cognition, emotion, and behavior. We consider negative psychological states, which have been the primary focus of psychological research in the context of COVID-19 (and psychoneuroimmunology more generally). We also consider positive psychological states, including positive affect and eudaimonic well-being, given increasing evidence for their importance as modulators of immunity. We finish with a discussion of interventions that may be effective in improving immune function, the neuro-immune axis, and ultimately, mental and physical health.

Daily provision of instrumental and emotional support to friends is associated with diurnal cortisol during adolescence

This study investigates how adolescents' daily prosocial behaviors to friends are related to diurnal cortisol using between- and within-subject analyses. Further, we examine whether role fulfillment (i.e., feeling like a good friend) moderates links between prosocial behaviors and cortisol. Ethnically diverse adolescents (N = 370; ages 11-18) reported whether they provided instrumental and emotional support to friends for 5 days, and provided four saliva samples/day for 4 days. On the daily level, providing emotional support predicted lower cortisol awakening response the next day, and providing instrumental assistance to friends was associated with a flatter cortisol slope the same day (a cardiovascular risk factor). Adolescents also provided more emotional support on days they had lower CAR and steeper cortisol slopes. On the average level, providing more instrumental support was associated with steeper cortisol slopes among adolescents who felt high levels of role fulfillment, but not among adolescents who felt low levels of role fulfillment. Providing instrumental support may be physiologically taxing from day to day but, across the long term, linked to lower cardiovascular risk for adolescents who experience helping as highly fulfilling.

In Dialogue: How Writing to the Dead and the Living Can Increase Self-Awareness in Those Bereaved by Addiction

This article examines how writing can increase the self-awareness of a socially isolated and often stigmatized population: those bereaved by addiction. Writing about a traumatic event has been shown to increase self-awareness which can improve health and regulate negative behaviors. Using narrative analysis on the writing of individuals bereaved by addiction, this study found that participants were able to increase their self-awareness through writing to the dead, the living and themselves. Participants’ writing also demonstrated their attempts to make sense and make meaning out of their loss which are both strong predictors of positive health outcomes. All participants in this study demonstrated increased self-awareness as well as sense-making and/or meaning-making which can lead to improvements in behavior regulation, psychological health and physical heath. This suggests that writing may be a uniquely beneficial therapeutic intervention for those experiencing disenfranchised grief as a result of bereavement by addiction.

Linguistic Markers of the Emotion Elaboration Surrounding the Confinement Period in the Italian Epicenter of COVID-19 Outbreak

The expressive writing method has rarely been proposed in contexts of large-scale upheavals that affect large populations. In this study this method was applied as an intervention and tool of investigation during the confinement period in the Lombardy region, the Italian Epicenter of COVID-19 outbreak. Sixty-four participants took part in an online expressive writing project, and a total of 167 writings were collected together with some self-report evaluations on emotions and physical sensations. A linguistic analysis through two different sets of computerized linguistic measures was conducted on the collected writings in order to study the linguistic markers of emotion regulation and elaboration. Results indicated that online expressive writing has helped respondents to get more in touch with the intense emotions that were experienced following the upheavals they witnessed. Writing even only once or twice helped, particularly those respondents who had at least one COVID-19 patient among close friends or relatives. Their writings showed an intense emotional involvement together with the ability to reflect and reorganize the personal meaning of the events and emotions experienced. This study shows that expressive writing can be used in the context of a psychological emergency, both as a powerful instrument to investigate and detect the complex psychodynamic processes underpinning the distress, and as a useful intervention to reduce the negative impact of traumatic events.

Contemplation by Design: Leveraging the "Power of the Pause" on a Large University Campus Through Built and Social Environments

College and university campuses have long been designed as embodied places of societal values and aspirations, reflecting both academic traditions and heritages alongside social and scientific change and innovation. More pragmatically, these spaces share some commonalities with other living and working environments, and must adapt to changing technological and social norms. Since the 1970's, workplace adaptations included employer-sponsored health promotion programs and facilities. While campus environments such as fitness centers and dining halls have been incorporated into health promotion initiatives, other aspects of human well-being have been neglected. In this paper, we describe an initiative, Contemplation By Design, to incorporate contemplation and mindfulness into the daily lives of all members of the Stanford University community, including students, faculty, staff, and their families, as well as alumni and retirees who live close by. This case study highlights ways that physical planning and programmatic initiatives for contemplative practices have been integrated to deliver generalizable, community-based well-being resources that can be emulated in diverse settings throughout the Stanford University campuses, including the main campus and local satellite campuses. Based on experience drawn from Contemplation By Design, practical recommendations for designing contemplative practice spaces and programs are offered.

Effectiveness of Stress-Reducing Interventions on the Response to Challenges to the Immune System: A Meta-Analytic Review

BACKGROUND

There is consistent evidence showing an interplay between psychological processes and immune function in health and disease processes.

OBJECTIVES

The present systematic review and meta-analysis aims to provide a concise overview of the effectiveness of stress-reducing psychological interventions on the activation of immune responses in both healthy subjects and patients.

METHODS

Included are 3 types of challenges: in vivo, in vitro, and psychophysiological. Such challenges are designed to mimic naturally occurring immune-related threats.

RESULTS

A systematic literature search was conducted using PubMed, EMBASE, and PsychInfo, resulting in 75 eligible studies. The risk of bias was assessed with the Cochrane risk-of-bias tool. Across all studies, a small-to-medium effect size was found for the effects of psychological interventions on optimization of the immune function (g = 0.33; 95% CI 0.22-0.43). While the largest effects were found for in vivo immune-related challenges (g = 0.61; 95% CI 0.34-0.88; especially on studies that incorporated skin tests and wound healing), studies incorporating psychophysiological challenges and in vitro immune-related stimulations similarly suggest more optimal immune responses among those receiving stress-reducing interventions (g = 0.28; 95% CI 0.15-0.42).

CONCLUSION

These findings showed substantial heterogeneity depending on the type of challenge, the study populations, and the intervention types. These data demonstrate support for the effectiveness of stress-reducing psychological interventions in improving immunity in studies that tested immune function by means of incorporating an in vivo,in vitro, or psychophysiological challenge. Future research should more consistently incorporate challenges into the study design to gather more insights in the mechanisms underlying the optimized immune function following a psychological intervention. This is also relevant for clinical practice, as psychological interventions can possibly supplement, or at least partially replace, current drug treatments in various somatic conditions to reduce side effects.

A Systematic Review of the Association Between Bereavement and Biomarkers of Immune Function

OBJECTIVE

Bereavement is associated with increased risk for morbidity and all-cause mortality across epidemiological, meta-analytic, and case-control studies. The body of research examining the association between bereavement and immune function, beginning in 1977, has yet to be reviewed. The current systematic review clarifies these findings, identifies limitations of the diverse literature, and suggests a model and directions for future research.

METHODS

The PRISMA guidelines for systematic reviews were used to synthesize 41 years of research. Compared with a meta-analysis, a systematic review is appropriate given the heterogeneous nature of the studies. We used the National Heart, Lung, and Blood Institute Study Quality Assessment Tool to assess the quality of select studies.

RESULTS

Thirty-three publications met inclusion criteria. Most studies support the association between bereavement and maladaptive changes in immune parameters in adults, with mixed findings on bereavement-related changes in cellular immunity. A handful of recent, good-quality studies show bereaved people demonstrate higher levels of systemic inflammation, maladaptive immune cell gene expression, and lower antibody response to vaccination compared with nonbereaved controls. Individual differences in psychological response to bereavement (e.g., depression, grief) seem to influence the association between bereavement and immune function.

CONCLUSIONS

Research examining the association between bereavement and biomarkers of immune function is heterogeneous in methods and quality. Despite these limitations, there is evidence supporting maladaptive changes in immune function after bereavement. The research area would benefit from longitudinal research with larger sample sizes, advanced immunological methods, and incorporating measures of psychological responses to bereavement. The field is poised to refine and scale up its investigation of this common and important phenomenon.

Psychological intervention based on psychoneuroimmunology improves clinical evolution, quality of life, and immunity of children with leukemia: A preliminary study

We conducted a non-randomized, open-label clinical trial to assess whether a psychoneuroimmunology-based intervention enhanced immunity in children with acute lymphoblastic leukemia undergoing chemotherapy. In total, 16 children (44% female) received psychoneuroimmunology-based intervention, whereas 12 (50% female) received health psychoeducation (controls). The primary outcome was immunity markers, being clinical conditions the secondary outcome. Psychoneuroimmunology-based intervention increased immune markers (CD8+ T, B, and natural killer cells, serum immunoglobulin A, and immunoglobulin M) and quality of life, whereas it shortens the duration of fever and use of antipyretics, antibiotics, analgesics, and respiratory therapy. Immunity markers correlated with clinical conditions. Thus, psychoneuroimmunology-based intervention could reduce hospital cost and increase patient well-being.

Psychobiological factors of resilience and depression in late life

In contrast to traditional perspectives of resilience as a stable, trait-like characteristic, resilience is now recognized as a multidimentional, dynamic capacity influenced by life-long interactions between internal and environmental resources. We review psychosocial and neurobiological factors associated with resilience to late-life depression (LLD). Recent research has identified both psychosocial characteristics associated with elevated LLD risk (e.g., insecure attachment, neuroticism) and psychosocial processes that may be useful intervention targets (e.g., self-efficacy, sense of purpose, coping behaviors, social support). Psychobiological factors include a variety of endocrine, genetic, inflammatory, metabolic, neural, and cardiovascular processes that bidirectionally interact to affect risk for LLD onset and course of illness. Several resilience-enhancing intervention modalities show promise for the prevention and treatment of LLD, including cognitive/psychological or mind-body (positive psychology; psychotherapy; heart rate variability biofeedback; meditation), movement-based (aerobic exercise; yoga; tai chi), and biological approaches (pharmacotherapy, electroconvulsive therapy). Additional research is needed to further elucidate psychosocial and biological factors that affect risk and course of LLD. In addition, research to identify psychobiological factors predicting differential treatment response to various interventions will be essential to the development of more individualized and effective approaches to the prevention and treatment of LLD.

Mechanisms of Risk Reduction in the Clinical Practice of Alzheimer's Disease Prevention

Alzheimer’s disease (AD) is a neurodegenerative dementia that affects nearly 50 million people worldwide and is a major source of morbidity, mortality, and healthcare expenditure. While there have been many attempts to develop disease-modifying therapies for late-onset AD, none have so far shown efficacy in humans. However, the long latency between the initial neuronal changes and onset of symptoms, the ability to identify patients at risk based on family history and genetic markers, and the emergence of AD biomarkers for preclinical disease suggests that early risk-reducing interventions may be able to decrease the incidence of, delay or prevent AD. In this review, we discuss six mechanisms—dysregulation of glucose metabolism, inflammation, oxidative stress, trophic factor release, amyloid burden, and calcium toxicity—involved in AD pathogenesis that offer promising targets for risk-reducing interventions. In addition, we offer a blueprint for a multi-modality AD risk reduction program that can be clinically implemented with the current state of knowledge. Focused risk reduction aimed at particular pathological factors may transform AD to a preventable disorder in select cases.

The therapeutic effectiveness of using visual art modalities with the bereaved: a systematic review

Bereaved individuals are increasingly considered at risk for negative psychological and physiological outcomes. Visual art modalities are often incorporated into grief therapy interventions, and clinical application of art therapy techniques with the bereaved has been widely documented. Although clinicians and recipients of these interventions advocate for their helpfulness in adapting to bereavement, research investigating the efficacy of visual art modalities has produced equivocal results and has not yet been synthesized to establish empirical support across settings. Accordingly, this review critically evaluates the existent literature on the effectiveness of visual art modalities with the bereaved and offers suggestions for future avenues of research. A total of 27 studies were included in the current review. Meta-analysis was not possible because of clinical heterogeneity and insufficient comparable data on outcome measures across studies. A narrative synthesis reports that therapeutic application of visual art modalities was associated with positive changes such as continuing bonds with the deceased and meaning making. Modest and conflicting preliminary evidence was found to support treatment effectiveness in alleviating negative grief symptoms such as general distress, functional impairment, and symptoms of depression and anxiety.

Emotion Language in Trauma Narratives is Associated with Better Psychological Adjustment among Survivors of Childhood Sexual Abuse

Traumatized individuals are often encouraged to confront their experiences by talking or writing about them. However, survivors of childhood sexual abuse (CSA) might find it especially difficult to process abuse experiences, particularly when the abuse is more severe, which could put them at greater risk for mental health problems. The current study examined whether CSA survivors who use emotion language when describing their abuse experiences exhibit better mental health. We analyzed the trauma narratives of 55 adults who, as children, were part of a larger study of the long-term emotional effects of criminal prosecutions on CSA survivors. Abuse narratives were analyzed using the Linguistic Inquiry and Word Count (LIWC) program. We examined whether positive and negative emotion language in participants' abuse narratives were associated with self- and caregiver-reported mental health symptoms and whether these associations differed according to the severity of the abuse. As hypothesized, participants who used more positive and negative emotion language had better psychological outcomes, especially when the abuse was severe. Our findings suggest that survivors of more severe abuse might benefit from including emotion language, whether positive or negative in valence, when describing the abuse.

Meaning in life and physical health: systematic review and meta-analysis

This systematic review and meta-analysis aimed to clarify the associations between meaning in life and physical health using random-effects models. Conceptualisation of meaning (order in world vs. purpose in life), type of health indicators, participants' health status, and age issues were investigated as moderators. Systematic searches of six databases resulted in inclusion of k = 66 studies (total N = 73,546). Findings indicated that meaning in life and physical health formed weak-to-moderate associations (the overall estimate of the average effect = 0.258). Conceptualisation of meaning, participants' health status, and their age did not moderate these associations. Operationalisation of health moderated the relationship between meaning in life and health. The strongest associations were found for subjective indicators of physical health. Significant albeit weak associations between meaning in life and objective indices of health were found. Furthermore, stronger effects were observed when the measures of meaning combined items referring to meaning in life and meaning-related sense of harmony, peace, and well-being, compared to measures focusing solely on meaning in life. Overall, the results point to the potential role of meaning in life in explaining physical health.

Moderators of the relationship between frequent family demands and inflammation among adolescents

OBJECTIVE

Frequent demands from others in relationships are associated with worse physiological and health outcomes. The present research investigated 2 potential moderators of the relationship between frequency of demands from one's family and inflammatory profiles among adolescents: (a) closeness of adolescents' relationships with their families, and (b) the frequency with which adolescents provided help to their families.

METHOD

Two hundred thirty-four adolescents, ages 13-16 (Mage = 14.53; 47.83% male), completed a daily dairy in which they reported on the frequency of demands made by family members. They were also interviewed about the closeness of their family relationships and reported in the daily diary on how frequently they provided help to their families. Adolescents also underwent a blood draw to assess low-grade inflammation and proinflammatory cytokine production in response to bacterial stimulation.

RESULTS

More frequent demands from family predicted higher levels of low-grade inflammation and cytokine production in response to bacterial stimulation in adolescents. Family closeness moderated the relationship between frequent demands and stimulated cytokine production such that more frequent demands predicted higher cytokine production among adolescents who were closer to their families. Furthermore, frequency of providing help moderated the relationship between frequent demands and both low-grade inflammation and stimulated cytokine production, such that more frequent demands predicted worse inflammatory profiles among adolescents who provided more help to their families.

CONCLUSIONS

These findings build on previous work on family demands and health to show under what circumstances family demands might have a physiological cost. (PsycINFO Database Record

Mindfulness and its efficacy for psychological and biological responses in women with breast cancer

Many breast cancer survivors have to deal with a variety of psychological and physiological sequelae including impaired immune responses. The primary purpose of this randomized controlled trial was to determine the efficacy of a mindfulness‐based stress reduction (MBSR) intervention for mood disorders in women with breast cancer. Secondary outcomes were symptom experience, health status, coping capacity, mindfulness, posttraumatic growth, and immune status. This RTC assigned 166 women with breast cancer to one of three groups: MBSR (8 weekly group sessions of MBSR), active controls (self‐instructing MBSR) and non‐MBSR. The primary outcome measure was the Hospital Anxiety and Depression Scale. Secondary outcome measures were: Memorial Symptom Assessment Scale, SF‐36, Sense of Coherence, Five Facets of Mindfulness Questionnaire, and Posttraumatic Growth Index. Blood samples were analyzed using flow cytometry for NK‐cell activity (FANKIA) and lymphocyte phenotyping; concentrations of cytokines were determined in sera using commercial high sensitivity IL‐6 and IL‐8 ELISA (enzyme‐linked immunosorbent assay) kits. Results provide evidence for beneficial effects of MBSR on psychological and biological responses. Women in the MBSR group experienced significant improvements in depression scores, with a mean pre‐MBSR HAD‐score of 4.3 and post‐MBSR score of 3.3 (P = 0.001), and compared to non‐MBSR (P = 0.015). Significant improvements on scores for distress, symptom burden, and mental health were also observed. Furthermore, MBSR facilitated coping capacity as well as mindfulness and posttraumatic growth. Significant benefits in immune response within the MBSR group and between groups were observed. MBSR have potential for alleviating depression, symptom experience, and for enhancing coping capacity, mindfulness and posttraumatic growth, which may improve breast cancer survivorship. MBSR also led to beneficial effect on immune function; the clinical implications of this finding merit further research.

Aging With Purpose: Systematic Search and Review of Literature Pertaining to Older Adults and Purpose

Purpose can provide a sense of intentionality, guide behavior to achieve personal aims and living objectives, and may offer insight into how and why certain people remain healthy over time. A review of the literature sought to identify contemporary research pertaining to purpose and older adults. Thirty-one studies were selected for evaluation based on inclusion criteria. Research outcomes suggest that greater reported purpose is related to a range of better health and well-being outcomes for older adults. With few exceptions, the literature demonstrates that purpose declines with age. Nevertheless, the potential to experience purpose persists across the life span, by providing opportunities for older adults to continue contributing roles, participate in meaningful activities, and sustain their social value and sense of relevance. Further research could explore how purpose is experienced by the oldest-old age-group, those living within noncommunity settings, and people with age-related cognitive impairment such as dementia.

Further Exploring the Link Between Religion and Existential Health: The Effects of Religiosity and Trait Differences in Mentalizing on Indicators of Meaning in Life

Religiosity contributes to perceptions of meaning. One of the cognitive foundations for religious belief is the capacity to mentalize the thoughts, emotions, and intentions of others (Theory of Mind). We examined how religiosity and trait differences in mentalizing interact to influence meaning. We hypothesized that people who are most cognitively inclined toward religion (high mentalizers) receive the greatest existential benefits (i.e., high and secure meaning) from religiosity. We assessed individual differences in mentalizing and religiosity, and measured indicators of meaning. Results confirmed that the combination of high mentalizing and high religiosity corresponded to the highest levels of existential health.

Meaning-Making Process Related to Temporality During Breast Cancer Traumatic Experience: The Clinical Use of Narrative to Promote a New Continuity of Life

Previous research has agreed that meaning-making is a key element in the promotion of patients' well-being during and after a traumatic event such as cancer. In this paper, we focus on an underestimated key element related to the crisis/rupture of this meaning-making process with respect to the time perspective. We consider 40 narratives of breast cancer patients at different times of treatment, undergoing chemotherapy and biological therapy. We collected data through writing technique. We performed an interpretative thematic analysis of the data and highlighted specific ways to signify time during the different treatment phases. Our central aspect "the time of illness, the illness of time" demonstrates that the time consumed by illness has the risk of becoming an illness of time, which transcends the end of the illness and absorbs a patient's past, present, and future, thus saturating all space for thought and meaning. The study suggests that narrative can become a therapeutic and preventive tool for women with breast cancer in a crisis of temporality, and enable the promotion of new semiotic connections and a specific functional resynchronization with the continuity/discontinuity of life. This is useful during the illness and medical treatment and also after the treatment.

Chronic pain care

Objective Experiencing pain not only affects patients' biopsychosocial functioning but also the existential domain. Attention to the existential, in addition to the biopsychosocial domains, might thus be important in chronic pain care. Therefore, we investigated: (a) how satisfied patients were with the attention of their practitioners to the impact of pain on biological, psychological, social, and existential life domains, and (b) how satisfaction with each domain was related to patient functioning. Method Pain patients ( N = 163) were questioned on their satisfaction with the attention of their practitioners to biological, psychological, social, and existential life domains, and on pain intensity, pain disability, life satisfaction, and depressive symptoms. Results Patients reported low satisfaction with the attention of their practitioners to the social and existential domains. Satisfaction with each domain was negatively related with pain intensity, pain disability, and depressive symptoms and positively related with life satisfaction. Only satisfaction with the existential domain was able to predict all functional outcomes above and beyond all other satisfaction variables modeled simultaneously. Conclusions Patients reported not feeling satisfied with the attention to the social and existential life domains. Furthermore, practitioners' attention to the existential domain seems highly important for patient functioning. Openness to existential concerns of pain patients might thus be an important aspect of chronic pain care.

The Role of Stress Management in the Relationship between Purpose in Life and Self-Rated Health in Teachers: A Mediation Analysis

Background: To examine whether stress management mediates the relationship between purpose in life and self-rated health status (SRH). Methods: A cross-sectional survey was conducted among 6840 teachers in 2013 in Guangzhou, China. Purpose in life was assessed through the Purpose in Life Subscale of the Psychological Well-being Scale. Stress management was assessed using the eight-item questionnaire adapted from the Health-promoting Lifestyle Profile II. SRH was assessed by the Suboptimal Health Measurement Scale Version 1.0. The mediation hypothesis was tested by the structural equation model for path analysis. Results: It was found that purpose in life had direct and indirect effects on SRH. The path analysis showed the total effect (β = 0.563) of purpose in life on SRH was comprised of a direct effect (β = 0.319) and an indirect effect (β = 0.244), which was mediated by stress management. Conclusions: By supporting the mediation hypothesis, our results indicate that stress management mediated the effect of purpose in life on SRH. Enhancement of teachers’ purpose in life and improvement of training skills of stress management should be incorporated in the strategy of improving teachers’ health.

Does Self-Affirmation, Cognitive Processing, or Discovery of Meaning Explain Cancer-Related Health Benefits of Expressive Writing?

Although expressive writing has positive effects on health, little is known about the underlying psychological mechanisms for these effects. The present study assessed self-affirmation, cognitive processing, and discovery of meaning as potential mediators of the effects of expressive writing on physical health in early-stage breast cancer survivors. A content analysis of the essays showed that self-affirmation writing was associated with fewer physical symptoms at a 3-month follow-up assessment, with self-affirmation writing fully mediating the effects of the emotional expression and benefit-finding writing conditions on reduced physical symptoms. Cognitive processing and discovery of meaning writing were not associated with any physical health outcomes. Consistent with evidence showing that self-affirmation plays an important role in buffering stress, the present study provides the first evidence for self-affirmation as a viable mechanism underlying the health benefits of expressive writing.

Discovery of Meaning and Adherence to Medications in HIV-infected Women

Discovery of meaning in response to illness has been linked to positive health outcomes. The mechanisms through which this occurs are unknown. This study tests a previously unexamined mechanism, engagement in healthier behaviors, which has been left uncontrolled in most studies. Forty-one HIV-infected women completed a one-month writing intervention. This writing was coded for signs of discovery of meaning. Adherence to medications was measured before (Time 1) and after (Time 2) the intervention. Women whose writing indicated that they had discovered meaning showed significantly greater adherence to their medical regimens at Time 2, controlling for Time 1 adherence. Discovery of meaning may result in positive health outcomes by leading individuals to engage in healthier behaviors.

Resilience, Meaning, and Well-Being

In this issue of The Counseling Psychologist, Smith presents an array of important strength-related literature and offers propositions, stages, and counseling recommendations to foster resilience among youth. This article argues, however, that the strength-based counseling model is not sufficiently operational or clearly distinguishable from other models and that more inclusion of the adult well-being literature could help to clarify key constructs and relationships among variables. The author proffers a focal operationalization of psychological resilience as generalized self-efficacy and discusses the importance of cultural moderators of resilience effects and meaning in life as a predictor of well-being. He recommends studying the incremental therapeutic benefits of strength-focused interventions.

Development and Preliminary Evaluation of the Existential Meaning Scale

Purpose: The aim of this study was to develop and examine the psychometric properties of the Existential Meaning Scale (EMS). Findings: Construct validity of the EMS was examined through factor analysis and correlational analyses with theoretically related instruments. After several weak items were deleted, the 20-item scale had a Cronbach’s alpha coefficient of > .80 in an overall sample of 418 individuals. Scores on the EMS were significantly lower in a sample of persons with HIV-1 infection than in the general population samples. Conclusion: Although its initial psychometric properties were satisfactory, additional validation of the EMS is necessary in other clinical populations to examine further the psychometric properties of the EMS. In addition, further examination of the responsiveness of the EMS over time is needed to evaluate its potential utility in longitudinal trials.

A reason to stay healthy: The role of meaning in life in relation to physical activity and healthy eating among adolescents

The present longitudinal study investigated the incremental contribution of meaning in life to sustaining health-promoting behaviors, after controlling for well-being and health values among East-European adolescents (N = 456). Time 1 responses on presence of meaning, search for meaning, well-being, and health values were used to predict levels of healthy eating and physical activity 13 months later. All independent variables significantly predicted engagement in healthy eating and physical activity. Presence of meaning and search for meaning were the most robust predictors, and the interaction of them predicted additional variance in healthy eating among boys and physical activity among girls.

Personality Strengths as Resilience: A One-Year Multiwave Study

We examined how personality strengths prospectively predict reactions to negative life events. Participants were 797 community adults from 42 countries. At five points over the course of 1 year, participants completed a series of questionnaires measuring seven personality strengths (hope, grit, meaning in life, curiosity, gratitude, control beliefs, and use of strengths), subjective well-being, and frequency and severity of negative life events. Using hierarchical linear modeling with assessment periods nested within participants, results from lagged analyses found that only hope emerged as a resilience factor. To illustrate the importance of using appropriate lagged analyses in resilience research, we ran nonlagged analyses; these results suggest that all seven personality strengths moderated the effect of negative life events on subjective well-being, with greater strengths associated with healthier outcomes. To provide evidence that personality strengths confer resilience, a prospective examination is needed with the inclusion of events and responses to them. The use of concurrent methodologies and analyses, which is the norm in psychology, often leads to erroneous conclusions. Hope, the ability to generate routes to reach goals and the motivation to use those routes, was shown to be particularly important in promoting resilience.

Cancer-related search for meaning increases willingness to participate in mindfulness-based stress reduction

OBJECTIVE

A cancer diagnosis can prompt an examination and reevaluation of life's meaning, purpose, and priorities. There is evidence that mindfulness-based stress reduction (MBSR) may help facilitate the meaning-making process. This study examined the influence of meaning in life on willingness to participate (WTP) in MBSR and identified factors associated with the search for and/or presence of meaning.

METHODS

A cross-sectional survey study of 300 patients undergoing radiation therapy was conducted. WTP in MBSR was dichotomized into yes/no by asking, "Would you participate in an MBSR program if it was offered at the cancer center?" The search for, and the presence of, meaning were assessed using the Meaning in Life Questionnaire.

RESULTS

Eighty patients (27%) indicated WTP in MBSR. In a multivariate logistic regression model, search for meaning was the only significant predictor of WTP in MBSR (adjusted odds ratio [AOR] =1.04, P ≤ .001, 95% CI = 1.01-1.08). Identifying as non-white (adjusted β = 4.62; 95% CI = 2.22-7.02; P < .001), and reporting subclinical (adjusted β = 3.59; 95% CI = 0.84-6.34; P = .01) or clinical levels (adjusted β = 5.52; 95% CI = 2.41-8.63; P = .001) of anxiety were the strongest predictors of search for meaning.

CONCLUSION

Our study indicates that patients searching for meaning are receptive to MBSR. Nonwhite patients and those experiencing high levels of anxiety are most likely to endorse a search for meaning. Future research is needed to understand how best to support patients who are searching for meaning and remove barriers to evidence-based programs like MBSR.

Finding meaning in life while living with HIV: validation of a novel HIV meaningfulness scale among HIV-infected participants living in Tennessee

BACKGROUND

People living with HIV who maintain a positive outlook on their future may manage stress better than those who do not, leading to improved coping behaviors and better health outcomes.

METHODS

While studying 125 HIV+ adults participating in two clinical trials of expressive writing we assessed their HIV-specific meaningfulness of life with a short, unidimensional scale (the HIVMS).

RESULTS

The HIVMS had a strong Cronbach's alpha (0.80) and acceptable test-retest reliability (0.70). HIVMS scores were strongly correlated with measures of perceived control, optimism, and psychological well-being. Participants with lower HIVMS scores had higher probability of non-adherence to antiretroviral medication, suggesting a decreased ability to manage their illness successfully. Neither the control nor expressive writing intervention groups showed increased HIVMS scores.

CONCLUSIONS

Future research is necessary to determine the effect of HIV meaning on long-term health outcomes and to develop interventions that can significantly improve a person's perception of their meaning in life.

Health and writing: meaning-making processes in the narratives of parents of children with leukemia

There is literary evidence stating that expressive writing affects health outcomes. Nevertheless, the processes underlying its benefits remain unclear. In our previous article, we described the benefits of writing; in this article, we investigate the meaning-making processes underlying the traumatic experiences of parents of children with leukemia in off-therapy. We collected the writings of 23 parents and grouped them according to the parents' psychological outcome (low/good/high) with respect to anxiety, as assessed during a follow-up. We qualitatively analyzed the texts written by parents with good psychological outcomes to highlight their main meaning-making processes, that is, how they put into words the shattering experience, reordered the events, connected their emotions and the events, reevaluated the event, and reconstructed the time process. We found that parents with low/high outcomes articulated these processes differently. Furthermore, we discussed the uses and functions of written narration for each group.

Writing content predicts benefit from written expressive disclosure: Evidence for repeated exposure and self-affirmation

Expressive disclosure regarding a stressful event improves psychological and physical health, yet predictors of these effects are not well established. The current study assessed exposure, narrative structure, affect word use, self-affirmation and discovery of meaning as predictors of anxiety, depressive and physical symptoms following expressive writing. Participants (N = 50) wrote on four occasions about a stressful event and completed self-report measures before writing and three months later. Essays were coded for stressor exposure (level of detail and whether participants remained on topic), narrative structure, self-affirmation and discovery of meaning. Linguistic Inquiry and Word Count software was used to quantify positive and negative affect word use. Controlling for baseline anxiety, more self-affirmation and detail about the event predicted lower anxiety symptoms, and more negative affect words (very high use) and more discovery of meaning predicted higher anxiety symptoms three months after writing. Findings highlight the importance of self-affirmation and exposure as predictors of benefit from expressive writing.

Integrating positive psychology into health-related quality of life research

PURPOSE

Positive psychology is an increasingly influential force in theory and research within psychology and many related fields, including behavioral medicine, sociology, and public health. This article aims to review the ways in which positive psychology and health-related quality of life (HRQOL) research currently interface and to suggest fruitful future directions.

METHODS

This article reviews the basic elements of positive psychology and provides an overview of conceptual and empirical links between positive psychology and HRQOL. The role of one central aspect of positive psychology (meaning) within HRQOL is highlighted, and unresolved issues (e.g., lack of definitional clarity) are discussed.

RESULTS

Some research on HRQOL has taken a positive psychology perspective, demonstrating the usefulness of taking a positive psychology approach. However, many areas await integration.

CONCLUSIONS

Once conceptual and methodological issues are resolved, positive psychology may profitably inform many aspects of HRQOL research and, perhaps, clinical interventions to promote HRQOL as well.

Purpose in life and use of preventive health care services

Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95% confidence interval (CI) = 1.08-1.29] or colonoscopy (OR = 1.06, 95% CI = 0.99-1.14). Furthermore, females were more likely to receive a mammogram/X-ray (OR = 1.27, 95% CI = 1.16-1.39) or pap smear (OR = 1.16, 95% CI = 1.06-1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95% CI = 1.18-1.45). Each unit increase in purpose was also associated with 17% fewer nights spent in the hospital (rate ratio = 0.83, 95% CI = 0.77-0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.

Lessons from writing sessions: a school-based randomized trial with adolescent orphans in Rwanda

BACKGROUND

Treatments for adolescents affected by long-term loss in low- and middle-income countries are lacking. As school-based interventions are cost-efficient and easy to disseminate, an evaluation of this treatment setting for adolescents is worthwhile.

OBJECTIVE

Examining the effect of a school-based unstructured emotional writing intervention (sensu Pennebaker, group 1) about the loss of a parent to reduce adaptation problems to loss, compared to writing about a hobby (group 2), and non-writing (group 3).

METHOD

We randomly assigned 14-18-year-old Rwandan orphans to one of the three conditions (n=23 per condition). Before and after the intervention, subjects completed the Prolonged Grief Questionnaire for Adolescents and the Mini International Neuropsychiatric Interview for Children and Adolescents, Part A, on depression as self-report measures of long-term effects of early parental loss.

RESULTS

Repeated measures analyses of variance showed no differential effect for any of the three conditions but revealed a significant effect of time at posttest regarding grief severity. Reduction of grief symptoms was significantly higher in subjects with elevated grief. Depressive symptoms showed no significant change from pre- to posttest in the emotional writing condition, whereas they significantly decreased in the control condition.

CONCLUSIONS

RESULTS imply that unstructured, brief emotional writing might not be indicated in adolescents affected by early parental loss who show severe and long-term distress; a more structured approach seems recommendable.

Purpose in life and reduced incidence of stroke in older adults: 'The Health and Retirement Study'

OBJECTIVE

To determine whether purpose in life is associated with reduced stroke incidence among older adults after adjusting for relevant sociodemographic, behavioral, biological, and psychosocial factors.

METHODS

We used prospective data from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50. 6739 adults who were stroke-free at baseline were examined. A multiple imputation technique was used to account for missing data. Purpose in life was measured using a validated adaptation of Ryff and Keyes' Scales of Psychological Well-Being. After controlling for a comprehensive list of covariates, we assessed the odds of stroke incidence over a four-year period. We used psychological and covariate data collected in 2006, along with occurrences of stroke reported in 2008, 2010, and during exit interviews. Covariates included sociodemographic factors (age, gender, race/ethnicity, marital status, education level, total wealth, functional status), health behaviors (smoking, exercise, alcohol use), biological factors (hypertension, diabetes, systolic blood pressure, diastolic blood pressure, BMI, heart disease), negative psychological factors (depression, anxiety, cynical hostility, negative affect), and positive psychological factors (optimism, positive affect, and social participation).

RESULTS

Greater baseline purpose in life was associated with a reduced likelihood of stroke during the four-year follow-up. In a model that adjusted for age, gender, race/ethnicity, marital status, education level, total wealth, and functional status, each standard deviation increase in purpose was associated with a multivariate-adjusted odds ratio of 0.78 for stroke (95% CI, 0.67-0.91, p=.002). Purpose remained significantly associated with a reduced likelihood of stroke after adjusting for several additional covariates including: health behaviors, biological factors, and psychological factors.

CONCLUSION

Among older American adults, greater purpose in life is linked with a lower risk of stroke.

Psychosocial stressors in inter-human relationships and health at each life stage: A review

Currently, psychosocial stressors' impacts on health are increasing. Among these stressors, this review focused on inter-human relationships. Since social supports could be protective against ill health, consequences contributing to psychosocial stressors are discussed here in relation to social supports for each stage of childhood, adulthood and elderly status.For childhood, parental divorce/isolation, and child abuse/neglect appeared to be determinants of healthy development at either the initial or later stages. According to prospective studies, such stressors, especially those occurring until around 3 years of age, were associated with later adverse life quality in adulthood. Therefore, nationwide preventive strategies were developed in each country to monitor protective social programs.For adulthood, job strain was focused on Karasek's job strain model, effort-reward imbalance, employment grade and working hours. These psychosocial stressors were shown to affect not only the physical health but also the mental health of working people. These days, since Karoshi and even suicide related to excessive workloads are taking a toll on workplace organization, stress-coping abilities such as a sense of coherence were introduced from the individual-social interaction aspect.For elderly status, retirement, caring for the elderly, and spouse bereavement were discussed as psychosocial stressors. Some evidence indicates that these stressors could be determiants of health. Finally, social supports have been demonstrated to promote health and protect the elderly against diseases and death.

Expressive talking among caregivers of hematopoietic stem cell transplant survivors: acceptability and concurrent subjective, objective, and physiologic indicators of emotion

This study sought to examine the effects of an expressive talking intervention for 58 caregiving partners of hematopoietic stem cell transplant survivors, persons known to experience distress. Caregivers were randomly assigned to a three-session emotional expression (EE) or control condition. Subjective, objective, and physiologic indicators of emotion were assessed. Relative to controls, EE participants experienced more negative emotion, uttered more negative emotion words, and perceived the exercises as more helpful and meaningful. The trajectory of skin conductance and the use of cognitive mechanism words increased across EE sessions, suggesting sustained emotional engagement. Future research is warranted to determine the optimal dose and timing of EE for this population.

A positive affect intervention for people experiencing health-related stress: development and non-randomized pilot test

In this article we present background, theoretical rationale, and pilot data on the development of an intervention designed to increase positive affect in people living with serious health-related stress. This proof-of-concept study demonstrated that a multiple-component positive affect intervention is feasible and acceptable for people newly diagnosed with HIV. Retention in the intervention and adherence to home practice were high. Participants reported significant increases in positive affect and significant decreases in negative affect. This positive affect intervention can serve as a template for programs to be developed to help people experiencing health-related and other types of life stress.

Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up

This study examined whether purpose in life was associated with myocardial infarction among a sample of older adults with coronary heart disease after adjusting for relevant sociodemographic, behavioral, biological, and psychological factors. Prospective data from the Health and Retirement Study-a nationally representative panel study of American adults over the age of 50-were used. Analyses were conducted on the subset of 1,546 individuals who had coronary heart disease at baseline. Greater baseline purpose in life was associated with lower odds of having a myocardial infarction during the 2-year follow-up period. On a six-point purpose in life measure, each unit increase was associated with a multivariate-adjusted odds ratio of 0.73 for myocardial infarction (95% CI, 0.57-0.93, P = .01). The association remained significant after controlling for coronary heart disease severity, self-rated health, and a comprehensive set of possible confounds. Higher purpose in life may play an important role in protecting against myocardial infarction among older American adults with coronary heart disease.