Who Benefits?

Limitations of benefit finding as a coping mechanism for combat-related PTSD symptoms

Benefit finding has been identified as a buffer of the combat exposure-PTSD symptom link in soldiers. However, benefit finding may have a limited buffering capacity on the combat-PTSD symptom link over the course of a soldier's post-deployment recovery period. In the present study, soldiers returning from Operation Iraqi Freedom (OIF) were surveyed at two different time periods post-deployment: Time 1 was 4 months post-deployment (n = 1,510), and Time 2 was at 9 months post-deployment (n = 783). The surveys assessed benefit finding, PTSD symptoms, and combat exposure. Benefit finding was a successful buffer of the cross-sectional relationship between combat exposure and PTSD reexperiencing symptoms at Time 1, but not at Time 2. In addition, the benefit finding by combat interaction at time 1 revealed that greater benefit finding was associated with higher symptoms under high combat exposure at Time 2 after controlling for PTSD arousal symptoms at Time 1. The results of the present study indicate that benefit finding may have a buffering capacity in the immediate months following a combat deployment, but also indicates that more time than is allotted during the post-deployment adjustment period is needed to enable recovery from PTSD. Theoretical implications are discussed.

Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients

OBJECTIVE

The purposes of the present study were to investigate the role of resilience in the prediction of emotional response in breast cancer patients and to examine whether this association is specific for women undergoing this emotionally taxing condition or whether resilience is more generally associated with higher levels of emotional well-being.

METHODS

Two hundred fifty-three breast cancer patients and 211 healthy female controls completed four psychological questionnaires. Measures comprised the Connor-Davidson Resilience Scale, the Hospital Anxiety and Depression Scale, Positive and Negative Affect Schedule, and two happiness items. Cancer patients were assessed after diagnosis and surgery.

RESULTS

Cancer patients reported higher levels of anxiety, depression, and negative affect and lower levels of positive affect and current happiness compared with control women. There was no difference between the two groups in level of resilience. Higher levels of resilience were related to better emotional adjustment both in women with breast cancer and in control women, but this association was stronger within the sample of cancer patients. In fact, patients scoring high on resilience seemed to experience similar levels of anxiety, depression, and current happiness as healthy women.

CONCLUSION

Our results confirm that resilience may at least partially protect against emotional distress in cancer patients. Our findings suggest that resilience may be a relatively stable trait that is not affected by adversity.

Post-traumatic growth in breast cancer survivors: new insights into its relationships with well-being and distress

Research investigating possible relations between Post-traumatic growth (PTG) and clinical indexes--such as psychosocial distress, physical and psychological well-being--is lacking in medical settings. The aim of this study was to look into such relationships in breast cancer survivors (Bcs) and in healthy control subjects who experienced other stressful events. Sixty Bcs and 60 healthy women reporting other stressful events were compared according to the following scales: Post-traumatic Growth Inventory, Psychological Well-being Scales (PWB), Symptom Questionnaire and Psychosocial Index. Bcs reported significantly higher levels of PTG and distress, and lower levels of PWB compared to healthy women. Bcs with high levels of PTG showed increased levels of physical well-being and decreased distress. Healthy women under stressful circumstances reporting high levels of PTG showed increased levels of PWB. PTG levels were higher in Bcs and associated with decreased psychological distress and somatisation. These results carry important implications for clinical assessment, as well as for planning interventions to improve well-being and resilience in oncology.

Complementary and alternative medicine use and benefit finding among cancer patients

PURPOSE

An increasing number of cancer patients are choosing Complementary and Alternative Medicine (CAM) as an active way to manage the physical, psychological, and spiritual consequences of cancer. This trend parallels a movement to understand how a difficult experience, such as a cancer diagnosis, may help facilitate positive growth, also referred to as benefit finding. Little is known about the associations between the use of CAM and the ability to find benefit in the cancer experience.

METHODS

We conducted a cross-sectional survey of medical oncology outpatients in an urban academic cancer center. Patients completed measures of CAM use and benefit finding following a diagnosis of cancer. A hierarchical regression, adjusting for covariates, was performed to evaluate the unique contribution of CAM use on benefit finding. The relationship between specific CAM modalities and benefit finding was explored.

RESULTS

Among 316 participants, 193 (61.3%) reported CAM use following diagnosis. Factors associated with CAM use were female gender (p=0.005); college, or higher, education (p=0.09); breast cancer diagnosis (p=0.016); and being 12 to 36 months post-diagnosis (p=0.017). In the hierarchical regression, race contributed the greatest unique variance to benefit finding (23%), followed by time from diagnosis (18%), and age (14%). Adjusting for covariates, CAM use uniquely accounted for 13% of the variance in benefit finding. Individuals using energy healing and healing arts reported significantly more benefit than nonusers. Special diet, herbal remedies, vitamin use, and massage saw a smaller increase in benefit finding, while acupuncture, chiropractic, homeopathy, relaxation, yoga, and tai chi were not significantly associated with benefit finding.

CONCLUSIONS

Patients who used CAM following a cancer diagnosis reported higher levels of benefit finding than those who did not. More research is required to evaluate the causal relationship between CAM use, benefit finding, and better psychosocial well-being.

Predictors of posttraumatic growth in women with breast cancer

OBJECTIVE

Posttraumatic growth (PTG) is defined as 'positive psychological change experienced as a result of a struggle with highly challenging life circumstances'. The current study examined change in PTG over 2 years following breast cancer diagnosis and variables associated with PTG over time.

METHODS

Women recently diagnosed with breast cancer completed surveys within 8 months of diagnosis and 6, 12, and 18 months later. Linear mixed effects models were used to assess the longitudinal effects of demographic, medical, and psychosocial variables on PTG as measured by the Posttraumatic Growth Inventory (PTGI).

RESULTS

A total of 653 women were accrued (mean age = 54.9, SD = 12.6). Total PTGI score increased over time mostly within the first few months following diagnosis. In the longitudinal model, greater PTGI scores were associated with education level, longer time since diagnosis, greater baseline level of illness intrusiveness, and increases in social support, spirituality, use of active-adaptive coping strategies, and mental health. Findings for the PTGI domains were similar to those for the total score except for the Spiritual Change domain.

CONCLUSION

PTG develops relatively soon after a breast cancer diagnosis and is associated with baseline illness intrusiveness and increases in social support, spirituality, use of active-adaptive coping strategies, and mental health.

A longitudinal investigation of posttraumatic growth in adult patients undergoing treatment for acute leukemia

An acute leukemia diagnosis can be an extremely stressful experience for most patients. Posttraumatic growth (PTG) is positive psychological change experienced following a struggle with highly challenging life circumstances. The current study is the first longitudinal investigation of predictors of PTG and distress in adult acute leukemia patients undergoing induction chemotherapy. Findings suggest that these patients report PTG, and levels of PTG appear to increase over the weeks following leukemia diagnosis and induction chemotherapy. Variables associated with higher total PTG scores over time included greater number of days from baseline, younger age, and greater challenge to core beliefs. Variables associated with higher distress included greater number of days from baseline, greater perceived cancer threat, higher symptom severity, and lower spiritual well-being. Results underscore the critical role that examination of one's core beliefs may play in the development of PTG over time.

A systematic review of resilience in the physically ill

BACKGROUND

Resilience is the capacity of individuals to maintain, or regain, their mental health in the face of significant adversity, including physical illness.

OBJECTIVE

We conducted a systematic review of resilience and related concepts in the physically ill to determine factors associated with predicting or promoting resilience.

METHODS

An electronic search of PsychInfo, Medline, and CINAHL databases between 1950 and May 2009 was performed using the terms resilience, and various types of physical illnesses. Inclusion criteria were broad and exclusion criteria were not published in English or not focused on resilience in physical illness.

RESULTS

A total of 475 articles were retrieved and 52 articles met inclusion/exclusion criteria. Psychological factors associated with resilience were self-efficacy, self-esteem, internal locus of control, optimism, mastery, hardiness, hope, self-empowerment, acceptance of illness, and determination. Social support was highly predictive of, and associated with, resilience. Coping strategies such as positive cognitive appraisal, spirituality, active coping, and mastery were also associated with resilience. Resilience factors directly salient to physical illness such as self-care, adherence to treatment, health related quality of life, illness perception, pain perception, exercise adherence, and physical outcomes were also found.

DISCUSSION

These findings need to be considered and when appropriate incorporated into the psychological and psychiatric care of physically ill individuals.

A naturalistic evaluation of psychosocial interventions for cancer patients in a community setting

We used a naturalistic methodology to examine associations between change in cancer patients' emotional functioning and their use of interventions in a community organization. One-hundred ninety-two patients completed measures at baseline and 6 months later. During this time, they utilized the organization's various interventions as they wished. Attendance at educational events was associated with decreased well-being. Use of art therapy groups was not associated with decreases in negative emotion but was consistently associated with increases in positive emotion. Improved functioning on some measures was associated with use of psychoeducational groups, expressive/supportive groups, movement classes, healing arts, and a buddy-matching service.

Post-traumatic growth and life threatening physical illness: a systematic review of the qualitative literature

Post-traumatic growth (PTG) is the phenomenon of positive change through the experience of trauma and adversity (O'Leary & Ickovics, 1995). Research suggests that the type of trauma sustained could have differing processes and outcomes from each other (Demark-wahnefried et al., 2000; Sabiston, McDonough, and Crocker, 2007). The aim of this study was to synthesize qualitative data on PTG and illness related trauma. Fifty-seven published journal articles dating from before November 1st, 2007 in PsychINFO, MEDLINE, EMBASE, Web of Knowledge and from the authors own knowledge of the area were reviewed. Key words included PTG; benefit finding; thriving and positive changes. Key themes included: 'reappraisal of life and priorities'; 'trauma equals development of self'; 'existential re-evaluation'; and 'a new awareness of the body'. Findings suggest that there are unique elements to illness related PTG and a need for additional research into the processes and outcomes of physical illness related trauma.