Cognitive processing, resilience, and family functioning as contributors to posttraumatic growth in family caregivers of patients with Alzheimer's disease

OBJECTIVES

The present study examined the existence of posttraumatic growth (PTG) and its association with cognitive processing, resilience, and family functioning in family caregivers of patients with Alzheimer's disease (AD).

METHOD

Family caregivers (N = 114) were surveyed using measures of cognitive processing, resilience, family functioning, and PTG. Data were analyzed using descriptive statistics, Pearson correlations, and multiple regression analyses.

RESULTS

The average PTG score in the sample was 48.6 (SD = 18.7; range 14-105). Race, education level, severity of the patient's AD, cognitive processing, resilience, and family functioning explained 25.8% of the variance in PTG (F [9, 95] = 5.025, p < 0.001). Race was significantly correlated with PTG; specifically, non-White caregivers reported higher PTG than White caregivers (p < 0.05). When controlling for race and education level, mild AD, intrusive rumination, and family satisfaction were significant predictors of PTG (p < 0.05). However, deliberate rumination, resilience, and family communication were not significant predictors PTG (p > 0.05).

CONCLUSION

These findings provide insight into factors that may influence the development of PTG in family caregivers of patients with AD. Results may inform intervention strategies to mitigate the negative consequences of caregiving and promote PTG in this caregiver population.

Promoting post-traumatic growth in cancer patients: a randomized controlled trial of guided written disclosure

Background

Cancer is a life-threatening disease that triggers not only vulnerability to distressing symptoms but also a meaning-making process that may lead to post-traumatic growth. As people often struggle to integrate cancer illness into their meaning system to reach an adaptive meaning, psychological interventions focused on a reappraisal of the illness experience can facilitate this process. This multicenter randomized controlled trial (RCT) was primarily aimed at assessing the efficacy of a writing intervention known as a guided disclosure protocol (GDP), compared to a generic writing intervention, in promoting post-traumatic growth in stage I-III breast and colon cancer patients at the end of their adjuvant chemotherapy.

Methods

Between January 2016 and August 2020 recruitment of eligible subjects took place during follow-up clinical consultations. Assessment occurred at baseline (T0), after the intervention (T1, 3 months from baseline), and at 6 months from baseline (T2). Both interventions consisted of three 20-min writing sessions to be performed once every two weeks. Change in post-traumatic growth was assessed using the Posttraumatic Growth Inventory, meaning with the Constructed Meaning Scale, and psychological distress with the Impact of Event Scale and the Hospital Anxiety and Depression Scale.

Results

In the five participating centers, 102 eligible patients were randomized and 72 participants completed follow-up evaluation. Most patients were women (79.4%), had breast cancer (68.6%), and stage I (27.5%), or stage II (44.1%) disease. Mean differences did not reach statistical significance for any of the dependent variables. However, an effect of the GDP, although not statistically relevant, was observed after the intervention in terms of enhanced post-traumatic growth and increased distress measured with the Impact of Event Scale.

Conclusion

This is the first RCT investigating the efficacy of a GDP in cancer patients having post-traumatic growth as the primary aim. Though GDP is a promising intervention in promoting post-traumatic growth, the lack of statistical significance of our findings may be due to the study being underpowered, hence this trial should be replicated with an adequate sample size, paying attention to supporting recruitment.

Clinical trial registration: ClinicalTrials.gov, identifier: 2015/0024360.

Psychosocial interventions on the posttraumatic growth of adults with cancer: A systematic review and meta-analysis of clinical trials

BACKGROUND

It has been increasingly recognized that some people experience post-traumatic growth (PTG) as a result of struggling with cancer.

OBJECTIVE

This systematic review aims to identify psychosocial interventions that might facilitate PTG in adults with cancer.

METHODS

A search was conducted in PsycINFO, PubMed, Scopus, the Cochrane Library, and ProQuest up to 16 September 2022. The PRISMA guidelines were followed; all included interventional studies had to comprise 30 or more adults with cancer, using the Posttraumatic Growth Inventory, from 1994 forward.

RESULTS

A total of 2731 articles were retrieved, 1028 of those were screened and 37 unique trials were included (46 articles). A large number of studies were published since 2018 (52.4%), were randomized controlled trials (43.2%), and had group interventions (34.8%), including mainly female participants (83.8%) with a single cancer type (54.1%). Most interventions (75.7%) were moderately to highly effective in increasing PTG (d = 0.65, 95% CI 0.39-0.91) with the most effective interventions using Cognitive Behavioral Therapy (d = 1.24, 95% CI: 0.05-2.44), Mindfulness-based (d = 0.54, 95% CI = 0.14-0.94) and Education, Peer Support and Health Coaching interventions (d = 0.28, 95% CI: 0.1-0.46). Expression-based and Positive Psychology-based approaches also showed promising results. Notably, the majority of studies had a high risk of bias.

CONCLUSIONS

PTG facilitation is a promising field that should be pursued as it not only allows people with cancer to overcome their trauma but also results in them going over and above their pre-cancer state, enhancing resilience, health, and well-being.

The Effect of Cognitive-Emotional Training on Post-traumatic Growth in Women with Breast Cancer in Middle East

Overcoming distresses and negative consequences of serious crises such as cancers can lead to perception of positive changes in the patients. It is necessary to design and test the psychological interventions that can improve post-traumatic growth. The objective of this study was to determine the effect of cognitive-emotional training on post-traumatic growth in women with breast cancer referred to the department of chemotherapy. This is a quasi-experimental study and it was performed on 85 patients with breast cancer who referred to an educational hospital in southeastern of Iran in 2017. The eligible patients were selected through convenience method sampling among the patients and they randomly allocated into intervention and control groups. The intervention group received five sessions of emotional-cognitive training in two sessions per week. Each session lasted 60-90 min. The posttest data were collected by post-traumatic growth inventory (PTGI) 20 weeks after the end of the last intervention session. Collected data were analyzed by SPSS software version 21.00 using independent t test, paired t test, and Chi-square tests for demographic analysis. The results indicated that there is no significant difference in both groups in terms of individual variables such as age, marriage, duration of disease, and degree progression of cancer. Although the mean of PTG scores in posttest and the mean of variations in the PTG scores in the intervention group were 77.48 ± 11.18 and 25.81 ± 12.24, respectively, and it was significantly higher than the control group, 53.95 ± 14.86 and 7.69 ± 9, respectively (mean scores of PTG: p < .0001; mean changes of PTG: p < .001). According to the results of this study, cognitive-behavioral intervention had a positive and significant effect on post-traumatic growth in women with breast cancer. If intervention is found to be effective, cognitive and emotional strategies of such interventions could be integrated into daily clinical practice as a way to promote PTG in women who are being treated for breast cancer.

[The acceptability of the intervention Revie ⊕ : the nurses’ perceptions and experiences]

Persons with advanced cancer experience high levels of existential distress due to being confronted with their mortality, which leads to feelings of lack of sense, or discouragement. It is important to develop interventions to relieve existential distress to promote the dignity of persons with advanced cancer in order to help them live this difficult experience in the best possible way. A new intervention, called Revie ⊕ and conducted by nurses, was developed. A feasibility study was conducted with 41 patients with advanced cancer in the ambulatory and hospital sector of a university hospital in Switzerland to determine the acceptability of Revie ⊕. The purpose of this article is to present the intervention’s acceptability from the perspective of the nurses. Nurses conducting the intervention were asked to complete a questionnaire, maintain personal notes, and to participate in one focus group. Descriptive statistics were used to analyze the questionnaire. Thematic analysis was applied to analyze the nurses’ personal notes and focus group data. Results indicate that nurses consider Revie ⊕ to be a beneficial intervention for the patients and also for their professional posture. As a consequence, the nurses wish for its implementation into practice. Recommendations are proposed to promote further implementation.

Revie ⊕: the influence of a life review intervention including a positive, patient-centered approach towards enhancing the personal dignity of patients with advanced cancer-a study protocol for a feasibility study using a mixed method investigation

BACKGROUND

It is generally recognized that existential concerns must be addressed to promote the dignity of patients with advanced cancer. A number of interventions have been developed in this regard, such as dignity therapy and other life review interventions (LRI). However, so far, none have focused on a positive approach or evaluated its effects on dignity and personal growth. This study aims to explore the feasibility of Revie ⊕, a life review intervention comprising a positive, patient-centered approach, and to determine potential changes of patients' sense of dignity, posttraumatic growth, and satisfaction with life.

METHODS

A mixed method study will be performed, which includes specialized nurses and 40 patients with advanced cancer in an ambulatory and in-patient setting of a Swiss university hospital. Quantitative methods involve a single group, pre- and post-intervention, and outcome measurements include the Patient Dignity Inventory, the Posttraumatic Growth Inventory, and the Satisfaction with Life Scale. Feasibility data relating to process, resource, and scientific elements of the trial will also be collected. A semi-directed interview will be used to collect qualitative data about the process and the participants' experiences of the intervention. In this way, enhanced quantitative-qualitative evidence can be drawn from outcome measures as well as individual, contextualized personal views, to help inform researchers about the plausibility of this complex intervention before testing its effectiveness in a subsequent full trial.

DISCUSSION

Patient dignity is a goal of quality end-of-life care. To our knowledge, this is the first trial to evaluate the role of a life review intervention that is focused on personal growth and on changes relating to the experience of having cancer. This study will evaluate the feasibility of a novel intervention, Revie ⊕, which we hope will contribute to promote the dignity, personal growth, and overall life satisfaction of patients with advanced cancer.

TRIAL REGISTRATION

ISRCTN, ISRCTN12497093.

Promoting post-traumatic growth in cancer patients: A study protocol for a randomized controlled trial of guided written disclosure

This multicenter study investigates the efficacy of the guided disclosure protocol in promoting post-traumatic growth, through meaning reconstruction, in cancer patients after adjuvant chemotherapy. Participants will be randomized to guided disclosure protocol or to an active control condition. Both conditions consist of three 20-minute writing sessions. Experimental participants verbalize emotions, describe events, and reflect on trauma effects. Control participants write about their past week’s daily routine. Patients, blinded to treatment assignment, will complete questionnaires at pre-intervention, post-intervention, and 6-month follow-up. This study will improve knowledge concerning the effects of writing interventions on psychological health and well-being in cancer patients.

Protocol for the psychotherapeutic group intervention for facilitating posttraumatic growth in nonmetastatic breast cancer patients

BACKGROUND

Breast cancer can be perceived as a traumatic event with disturbing effects on psychological domains such as depression, anxiety, and Posttraumatic Stress Disorder. In contrast, growing evidence has shown that posttraumatic growth can occur as a result of coping with breast cancer. Challenging the assumptive world, deliberate rumination, and emotional disclosure are recognized as strong predictors of posttraumatic growth. Group interventions may also increase social support, distress disclosure, and posttraumatic growth. The aim of this study is to evaluate how group-based interventions can facilitate posttraumatic growth and promote improved psychosocial adjustment to breast cancer. This article describes the study protocol and the applied research methods.

METHODS

To measure the impact of a group-based intervention on posttraumatic growth, a multi-center randomized control trial was developed for Portuguese breast cancer patients. 205 women with nonmetastatic breast cancer (stages 1 to 3) were recruited for the study and were randomly assigned either to the experimental group, which participated in an 8-session group intervention, or to the control group. Psychosocial variables, which consisted of posttraumatic growth, illness perception, stressfulness of the event, Posttraumatic Stress Disorder, core beliefs, rumination, social support, and distress disclosure were measured at three time points. The designated points in time for the assessments were baseline, 6 months post-intervention, and follow-up (12 months after baseline).

DISCUSSION

This study is the first trial to assess the efficacy of a group-based intervention designed to facilitate posttraumatic growth following a breast cancer diagnosis. If proven to be effective, group-based intervention could be recommended as a complementary program to be included in hospital health-care and clinical practice.

TRIAL REGISTRATION

The trial was registered on 28/10/2013 at the Current Controlled Trials ( ISRCTN02221709 ).

Spiritual Coping: A Gateway to Enhancing Family Communication During Cancer Treatment

The researchers examined the spiritual coping, family communication, and family functioning of 95 participants in 34 families by an online survey. Multilevel linear regression was used to test whether individuals' and families' higher endorsement of more use of spiritual coping strategies to deal with a member's cancer would be associated with higher scores on family communication and family functioning, and whether better communication would also be associated with higher family functioning scores. Results revealed that spiritual coping was positively associated with family communication, and family communication was positively associated with healthier family functioning. The researchers provide suggestions for further research.

Posttraumatic growth moderates the effects of posttraumatic stress symptoms on adjustment and positive affective reactions in digestive system cancer patients

The study aims were twofold: (1) To investigate the associations of posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) with adjustment and affective reactions of digestive system cancer patients and (2) To assess the moderating effects of PTG on the associations of PTSS with adjustment and affective reactions. The sample consisted of 200 respondents 1-4 years following diagnosis and treatment for digestive system cancer. Participants completed questionnaires assessing PTSS, PTG, adjustment, positive affect (PA), and negative affect (NA). The results showed that PTG was positively associated with adjustment and PA, while PTSS was negatively associated with these outcomes and positively associated with NA. Moderation effects of PTG were also observed: The negative associations between PTSS and adjustment or PA were weaker under high levels than under low levels of PTG. It was concluded that PTG is important both as a contributor to better adjustment and PA, as well as a moderator of the detrimental effects of PTSS on adjustment and PA following recovery from cancer. Thus, when developing post-cancer intervention programs, PTG should be viewed as a factor to be encouraged and nurtured for the benefit of cancer patients' adjustment and their long-term well-being.

A non-randomised trial of an art therapy intervention for patients with haematological malignancies to support post-traumatic growth

The aim of this study was to determine the effect of art therapy on post-traumatic growth in patients with haematological malignancies in a non-randomised trial ( n = 36, intervention group; n = 129, control group). Art therapy was administered over a period of 22 weeks in small groups. Post-traumatic growth was measured with the Stress-Related Growth Scale. After controlling for the effect of potential confounders, no difference in post-traumatic growth was observed between the intervention and control groups after 22 weeks. There was no evidence for an effect of weekly group sessions with art therapy on post-traumatic growth in patients with haematological malignancies.