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

Religion, culture, and cancer: insights from a qualitative study on coping experiences of Filipino patients

Introduction

Meaning-making coping is used by people with cancer to help them deal with the stress and emotional turmoil associated with their diagnosis. It is a multifaceted approach that can be influenced by cultural, existential, and personal factors. Research on meaning-making coping among Filipinos diagnosed with cancer is sparse. This study examines how a sample of Filipino people with cancer cope with their illnesses.

Methods

We employed a qualitative approach. The study involved 20 participants with various types of cancer in the Philippines who were selected through purposive sampling and agreed to be interviewed.

Results

The thematic analysis of the interviews revealed the application of both religious and secular meaning-making coping by participants. The study also confirmed the potential influence of culture on coping strategies.

Discussion

The results indicate that religion plays a significant role in Filipino coping mechanisms, given that the Philippines is predominantly a Christian nation. Additionally, the findings highlight the importance of close family ties in Filipino culture and how it contributes to coping with cancer.

Specificity and integration of meaning in self-defining memories of breast cancer survivors: clinical reflections to promote a narrative identity integration

Potential traumatic events, such as breast cancer, can influence autobiographical memory (AM), interrupting the continuity of narrative identity. AM is based on a hierarchical search across different levels of specificity that are indexed from top to bottom when a memory is retrieved. In the breast cancer field, non-specific AMs are an observed clinical phenomenon. In particular, breast cancer survivors report issues related to self-defining memories (SDMs), specific and significant AMs that evoke strong emotions and sensory details at the time of memory. SDMs are linked to life goals and facilitate adaptation to critical experiences, preserving the continuity of identity. This study explored the narrative identity integration process of breast cancer survivors, analyzing themes, specificity, and integrative meaning in SDMs. Ten women participated in an online group support program centered on the integration of AMs linked to the cancer journey. Participants were asked to assess their body image perceptions, filling out an online survey three times, in which they had to report three SDMs each time. A reflexive thematic analysis of the SDMs identified three main themes: the onset of breast cancer; the labeling of negative emotions, and changes in the body. The results indicated inhibited retrieval of specific episodes, fostering a progressive failure in memory characterization and the concurrent meaning-making process. Participants struggled with connecting the memories to insights regarding their self and life, as well as relating the memories to external conditions and other individuals. Further studies might examine the impact of these difficulties on the psychological adjustment of BC long-term survivors. They could also explore cognitive reconstruction by reframing the memories and re-evaluating their traumatic meanings.

Dignity and time perspective: A pilot explorative study in cancer patients

OBJECTIVES

This study investigated the possible correlation between emotional distress linked to dignity and dysfunctional temporal orientations in the oncological context.

METHODS

We conducted an exploratory study between December 2020 and February 2021, referring to a sample of 107 patients in active treatment for solid tumors belonging to the Oncology Department of the Fondazione Poliambulanza (Brescia, Italy). We administered two self-report questionnaires: the Patient Dignity Inventory (PDI-IT) (Italian version, Grassi L, Costantini A, Caruso R, et al. (2017) Dignity and psychosocial-related variables in advanced and nonadvanced cancer patients by using the patient dignity inventory-Italian version. Journal of Pain and Symptom Management 53(2), 279-287), as a measure of perceived level of dignity, and the Italian version of the Zimbardo Time Perspective Inventory scale (ZTPI) (Zimbardo PG and Boyd JN (2009) Il paradosso del tempo. La nuova psicologia del tempo che cambierà la tua vita. Milano: Mondadori), as a measure of the experiential dimensions of time, such as past, present, and future.

RESULTS

From the PDI-IT emerged that our sample reported high levels of physical and psychological distress. Furthermore, we founded higher distress in patients under 55 years (p = 0.04) and lower distress in retired patients (p = 0.01). The ZTPI showed in our patients prevailing orientations to the past-positive (39.3%) and the future (37.4%). We noticed a gender difference: men were mainly oriented to the future while women to the past-positive. Moreover, married subjects reported a prevalent orientation to past-positive and the future. Finally, data analysis found moderate positive correlation between the "Negative Past" dimension of ZTPI and high levels of physical (r = 0.203, p = 0.03) and psychological distress (r = 236, p = 0.01).

SIGNIFICANCE OF RESULTS

In our experience in oncology, dignity and time perspective play a central role as indicators of the quality of care. Our study shows the importance of a treatment path that integrates the constructs of Dignity and Time Perspective to favor a better psychological adaptation.

The Role and Function of Autobiographical Memory Narratives during the Emotional Processing of Breast Cancer Treatment: An Empirically-Derived Memory Coding System

Breast cancer (BC) in younger age is a critical and potentially traumatic experience that can interrupt the continuity of self-narrative during a crucial phase. In the Narrative Identity framework the translation of memories into autobiographical narratives is an internal and external process that plays a key role in meaning-making, social relationships and self-coherence. The aim of this study is to examine the role and function that autobiographical memory narratives (AMN) play in the process of adaptation to BC medical treatment. Seventeen BC women below 50 years received prompts to provide autobiographical memory narratives at four phases during their treatment (pre-hospitalization-T1-post-surgery-T2-chemo-radio therapy-T3-follow-up-T4). The Emotional Processing Scale (EPS) was also administered. In all, 68 AMN were collected. A three step procedure of data analysis was conducted. The first one, an empirically-derived memory coding manual to analyze key dimensions of AMN was developed: Agency; Emotional Regulation and Interpersonal Relations. Findings show a particular vulnerability in narrative identity faced by BC women during the shift from T1-T3. In the second one, an emotional coping profile for each woman focusing on the shift from T1-T3 was created. For the third step, these profiles were compared with the EPS scores. The final results suggest the capacity of the AMNs to differentiate the women's emotional adaptation over the course of the BC treatment. Despite the study's limitations, it supports the use of AMN as clinical device to construct a deeper knowledge and profiling trajectory of how women have internalized and elaborated past encounters with illness and help providers, as well as their prior experience of bodily/psychological health and integrity. This information adds to an understanding of their current efforts at recovery and adaptation. In this way we believe that the recollection of narrative memories, not only at the end of the cancer treatment but also during its process, could help the women to mend the broken continuity of their narrative self, as they seek to maintain a healthy balance of internal resources across their past, present, and projected future.

Perspective of Uncertainty and Emotional Responses in Breast Cancer Patients During the COVID-19 Pandemic

Introduction

Breast cancer is a chronic disease that has implications for many aspects of the patient's life. Contracting the COVID-19 virus places cancer patients at a higher risk of infection. This condition triggers uncertainty which causes emotional responses.

Objective

The aim of this study was to measure the relationship between the uncertainty perspective of breast cancer patients and emotional responses during the COVID-19 pandemic.

Methods

This study used an observational study with a cross-sectional design. Data was collected from May to December 2021. The total sample of this study was 110 breast cancer patients undergoing chemotherapy at the Army Hospital of Dr. Soepraeon Malang, Indonesia. We used purposive sampling. The questionnaire used was a modified questionnaire from the Mishel Uncertainty in Illness Scale, a modified questionnaire from the Concerns about Recurrence Questionnaire, a modified questionnaire from the Zung Self Rating Anxiety Scale, and a modified questionnaire from the Depression, Anxiety, and Stress Scale. Data was analyzed using SPSS with a Spearman correlation test.

Results

The mean uncertainty of the respondents was 75.98 or in the moderate category, emotional response was moderate fear with a mean score of 18.40, the average anxiety score was 41.05 or normal, and the mean depression score was 15.96 or low depression. In addition, there was a significant relationship between uncertainty and the emotional response among breast cancer patients in the era of the COVID-19 pandemic (p < .05).

Conclusion

This study showed that there was a relationship between uncertainty and emotional response among breast cancer patients. It is important for nurses to provide good information about the disease among patients by using therapeutic communication and paying attention to the negative emotional responses of breast cancer patients.

Self-Compassion: The Factor That Explains a Relationship between Perceived Social Support and Emotional Self-Regulation in Psychological Well-Being of Breast Cancer Survivors

Objective: Perceived social support (PSS) and emotional self-regulation have customarily been related to greater psychological well-being, but the pathways via which perceived social support and emotional self-regulation increase psychological well-being have not been revealed. We investigated how much self-compassion mediated the association between perceived social support and emotional self-regulation in psychological well-being of breast cancer sufferers. Method : A cross-sectional study design was used. Participants were recruited from three oncology departments in Zanjan, Iran. Data was collected from breast cancer patients (n = 300). Participants completed self-report measures, the short Ryff scale Psychological Well-being (RSPWB), Emotion Regulation Questionnaire (ERQ), Multidimensional Scale of Perceived Social Support (MSPSS) and Self-Compassion Scale (SCS). Pearson correlation coefficient was used to assess association among the study variables and multivariable regression analysis was used to assess linear relationships among predictor variables (emotional self-regulation, perceived social support and self-compassion) and criterion variable (psychological well-being). Bootstrapping analyses were used to test the significance on indirect effects. Results: Bootstrapping analyses revealed significant indirect effects of perceived social support (β = 0.055, SE = 0.45, P = 0.049, 0.95 CI: LL = 0.0092, UL = 0.1345) and emotional self-regulation (β = 0.079, SE = 0.079, P = 0.004, 0.95 CI: LL = -0.0331, UL = -0.1358) on psychological well-being through self-compassion. Conclusion: These findings present new evidence that self-compassion may be a target for psychological interventions attempted at enhancing psychological well-being in cancer populations, particularly breast cancer survivors.

Allostatic Load as an Insight into the Psychological Burden after Primary Treatment in Women with Breast Cancer: Influence of Physical Side Effects and Pain Perception

Breast cancer (BC) diagnosis and treatment have become a cumulative long-standing chronic disease impairment, causing stress and turning into an allostatic load (AL) framework. This study aimed to investigate the relationship between physical issues and mental health in patients with BC after medical treatment. We conducted an observational study of 61 female patients with BC, and clinical and psychological markers have been detected. We conducted descriptive statistics, ANOVA analyses, correlations, and mediation analyses to verify the effect of the comorbidity index on psychological dimensions. The findings showed high levels of distress and moderate pain, and 32.8% of the patients showed moderate physical impairment. Significant effects of “age” and “physical issues” were found. The adult group reported a higher incidence of physical issues, and the group of patients reporting moderate physical impairment seemed more depressed than patients with mild physical issues. Finally, the comorbidity condition mediated the presence of signs of depression. Patients with BC seemed to experience negative emotions related to comorbidities associated with compromised activities of daily living. Our findings highlighted allostatic overload as a predictive framework to better understand the mental health of women with BC diagnoses to tailor effective psychological treatments for enhanced recovery.

The Time Moving exhibit: Exploring perceptions of time in end-of-life experiences

BACKGROUND

Conversations about end of life rarely take place beyond healthcare spaces and in advance of imminent death. As the Canadian ageing population increases and new policies and options emerge for end-of-life choices, there will be an increasing need for supports for decision-making on end of life. Time Moving was a participatory art exhibit created to engage participants in reflections on end-of-life experiences and the ways in which their perception of time fluctuated within these moments.

DESIGN

A participatory and constructivist approach informed decisions on exhibit design and analysis. The Time Moving exhibit was installed in a downtown university hall for 10 days during the 2019 annual DesignTO festival, open to all members of the public. The exhibit was used as the primary method of data collection. There were three prompts informed by concepts from prior work on time perception. Participants were invited to respond by drawing, writing or constructing.

OUTCOME

There were over 120 contributions of participants over the duration of the Time Moving exhibit. These contributions revealed new insights related to temporal perception and end-of-life experiences. Participants shared their perception of time during end-of-life experiences in a variety of ways, revealing a diversity of perceptions of time beyond calendar and clock time, including time experienced as a spiral.

CONCLUSIONS

The insights on time perception highlight opportunities for approaching dialogue on end of life and in grief support, and for exhibit as a mechanism for research and education.

PATIENT OR PUBLIC CONTRIBUTION

As a public exhibit, over 120 people contributed ideas, personal stories, drawings and other creative outputs to the exhibit. An estimated 250 people visited the exhibit.

Sex differences in the outcome of expressive writing in parents of children with leukaemia

Background

Sex differences are widely reported in clinical psychology but are rarely examined in interventions.

Method

This mixed-method explorative study examined sex differences in 13 mothers and 10 fathers of children in the off-therapy phase of acute lymphoblastic leukaemia. Parents underwent an expressive writing intervention using the guided written disclosure protocol (GWDP).

Results

Mothers had more negative mood profiles than fathers but improved more during the intervention.

Conclusion

Though preliminary, our findings highlight the importance of sex as a potential moderator of intervention and treatment outcome that could be of great clinical significance.

Parents of children in remission from cancer can benefit from expressive writing.

Expressive writing can improve mood states.

Mothers may benefit more than fathers.

More research on gender differences in outcomes is needed.

Anticipatory Mourning and Narrative Meaning-Making in the Younger Breast Cancer Experience: An Application of the Meaning of Loss Codebook

Breast cancer (BC) in women under 50 is a potentially traumatic experience that can upset a woman's life during a crucial phase of her lifespan. Anticipatory mourning linked to the diagnosis of BC can produce a series of inevitable losses similar to those of the bereaved. Narration can be one tool to construct meaning, to grow through the experience, and reconfigure time perspectives during and after the illness. The aim of this study was to apply the Meaning of Loss Codebook (MLC) to the narrative context of young women with BC. An ad hoc narrative interview was administered to 17 women at four times during the first year of treatment. A thematic analysis was performed using the MLC, adopting a bottom-up and top-down methodology. The results highlight the MLC's usefulness in capturing the experiences of the women, allowing for a greater appreciation of the nuances of the meanings embodied in their narratives. The thematic categories grounded in the MLC cover the whole experience of BC during the first year of treatment, attesting to the possibility of extending the use of the MLC to observe the longitudinal elaboration of the psychic experience of BC in addition to its established validity in the context of bereavement and loss.

Living in Rural Areas and Receiving Cancer Treatment Away From Home: A Qualitative Study Foregrounding Temporality

We used explorative interviews to gauge (inter)personal, physiological, and emotional challenges of seven rural cancer patients who traveled long distances to cancer treatment centers. After a thematic analysis, we foregrounded experiences of temporality by using a phenomenologically inspired approach. The analysis resulted in three themes: (a) An epiphany of “what really matters in life”—time gains new meaning, (b) Feeling out of sync with others and own body—striving for coherence and simultaneity, and (c) Being torn between benefits of home and treatments site—time and distance as a tangible aspect of traveling and being away. Under these themes, 13 meaning units were generated, which reflected changes in temporality. During treatment, life primarily revolved around repeating circles of travel arrangements, staying on top of treatment schedule, and synchronizing a home life with a life away from home. Nurses should provide comprehensive care to enhance stability in cancer patients’ temporal experiences.

The incurable metastatic breast cancer experience through metaphors: the fight and the unveiling

Purpose: War metaphors are omnipresent in public and medical discourse on cancer . If some studies suggest that cancer patients may view their experiences as afight, few studies focus on the metaphors that patients create from their subjective experiences. The aim was to better understand the experience of four women with incurabale metastatic breast cancer from the metaphors they used in personal cancer blogs.Methods: An interpretive phenomenological analysis (IPA) was used to analyze these women's experience and metaphors of cancer.Results: Two metaphors carried the meaning of metastatic breast cancer experience: the fight and the unveiling. The results show that the war metaphor had a unique meaning for the bloggers who lived with incurable breast cancer: they revealed the difficulty of fighting cancer and eventually collapsing in battle, although a renewed look at life had developed in parallel to their struggle. The bloggers thus tried to lift the veil on this complex experience.Conclusion: The results highlight the need for women with metastatic breast cancer to be able to tell and share their experience in a supportive context and to reinvest the war metaphor in order to express themselves in a more authentic way.

A review of psychological impact of breast cancer in women below 50 years old

A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.

The Meaning of Temporal Balance: Does Meaning in Life Mediate the Relationship Between a Balanced Time Perspective and Mental Health?

The construct of a Balanced Time Perspective (BTP) predicts a variety of indices of mental health and well-being. We argue that one possible intermediate link between BTP and well-being may be an individual’s sense of presence of meaning in life. Participants ranging in age from 19 to 88 years (N = 192) completed two measures of time perspective (Zimbardo Time Perspective Inventory [ZTPI] and the modified Balanced Time Perspective Scale [mBTPS]), mental health, personality, and meaning in life. Correlational results showed that a BTP, mental health, and meaning in life were positively interrelated. Hierarchical regression models showed that a BTP (as measured with the mBTPS) explained additional variance in mental health beyond demographic, personality, and ZTPI scores. Mediation analyses showed that meaning served as a significant indirect link between BTP and well-being.

Meeting death and embracing existential loneliness: A cancer patient's experience of being the sole author of his life

Facing the truth of death in silence instead of fearing and denying it enables people to regain their freedom. This qualitative case study aimed to illuminate the meaning of a single person's experience of confronting death and living with cancer. The transcripts of unstructured interviews were analyzed using the hermeneutic phenomenological method. Data analysis led to extraction of four themes including "Confronting death, meeting nonbeing and longing for being", "Embracing existential loneliness, responsibility and freedom", "Taking over the mind, living mindfully, a meaningful life", and "Flourishing authentic self-love, moving in the path of caring and healing the self".

The Semiotic Construction of the Sense of Agency. The Modal Articulation in Narrative Processes

The sense of agency is an ongoing process of semiotic construction of the action starting from the affective, cognitive, intersubjective and cultural matrix of experience. A person narratively constructs the sense of her agentive experience and in doing so does not refer exclusively to the "what", but also to the "how". There is always a specific "modus" to experience one's own action. We present the psychological notion of the Modal Articulation Process (MAP), namely the way through which a person orients and configures in a contextual frame the sense of her actions by means of modal operators of necessity, possibility, impossibility, contingency, but also knowledge, will, capability, constrain and opportunity. The notion of Modal Articulation Process is proposed as a semiotic, dynamic and recursive process that articulates narratively many aspects of the agency: the relational positionings and the way of experiencing them, the constraints and the resources present in the socio-symbolic context, the inherent temporality of every human phenomenon. Although the study of modal operators has an ancient and solid tradition of research in the fields of modal logics, analytical philosophy and narrative semiotic disciplines as well, yet in the field of the psychological sciences - except for a few authoritative isolated cases (Kurt Lewin, Rom Harrè, Jaan Valsiner) - there is not a great deal of attention on the relevance of these symbolic devices and their function in constructing the sense of action in a narrative way. Indeed modal articulation processes are at stake both during daily common routines and during exceptional turning point experiences that request a reconfiguration of the sense of one's own agency (e.g. the experiences of illness demand a new modal re-articulation). Our discussion is aimed at deepening and developing the notion of modal articulation, its functions and its specificities.

A Systematic Review of Metacognitive Beliefs in Chronic Medical Conditions

Background: Psychological functioning plays an important role in medical conditions and impacts patients' quality of life. Previously, many studies have highlighted the association of metacognition to both the development and maintenance of emotional disorders. Recently, several researchers pointed out the relevant role of dysfunctional metacognitive beliefs in the context of chronic diseases. Hence, dysfunctional metacognitive beliefs could be directly related to anxiety and depression, regardless of the medical condition's expression. The aim of this systematic review was to summarize the available evidence regarding the association of metacognition with anxiety, depression, and perceived quality of life, in the context of medical conditions, according to Wells' theory.

Methods: A systematic review based on electronic bibliographic databases (PsycINFO, PubMed, Scopus, Web of Science, and Web of Knowledge) of scientific literature was carried out. Studies involving patients evaluated in clinical settings were included in the analysis.

Results: Our findings indicated that metacognition appears to be related to anxiety, depression, and quality of life in patients with medical chronic conditions. Therefore, dysfunctional metacognitive beliefs might be a relevant factor associated with the process of adapting to illness.

Conclusions: The additional evaluation of metacognitive factors in the context of several medical chronic conditions appears valuable. Due to the rising interest in the study of metacognition, suggestions for future research have also been provided.

Religion, Culture and Meaning-Making Coping: A Study Among Cancer Patients in Malaysia

The present study aimed to explore the use of meaning-making coping mechanisms (existential, spiritual and religious coping) among ethnic Malay cancer patients in Malaysia and to investigate the impact of culture on their choice of coping methods. Twenty-nine participants with various kinds of cancer were interviewed. Four kinds of coping resources emerged from analyses of the interview transcripts: (1) relying on transcendent power, (2) supernatural or mystical beliefs, (3) finding oneself in relationships with others and (4) nature. In this article, the two first resources are in focus. The present findings suggest that Malay culture, which is imbued with Islamic belief, strongly influences cancer patients' coping methods and ways of looking at their experience of being cancer patients.

Coping strategies among patients with malignant lymphoma- a qualitative study from the perspectives of Swedish patients

PURPOSE

There is a dearth of research on coping strategies of patients with malignant lymphoma. The aim of this article is to explore how these patients cope with cancer in everyday life.

METHOD

Semi-structured interviews were conducted with nine patients in Sweden. A thematic analysis was made, inspired by Antonovsky's theory of sense of coherence. The SRQR checklist was used.

RESULTS

Patient's coping strategies are shown within three themes: 'Life experiences supported coping strategies during treatment', 'Between completed treatment and (possible) cure', and 'Illness brought closeness and distance in social relationships'. Three different coping strategies were identified during treatment: trying to control the situation, seeing opportunities in difficulties, and doing other activities to limit thoughts about disease and treatment. Four different coping strategies were identified after treatment ended, namely projecting responsibility and anger onto the healthcare system, maintaining the outer facade as a strong person who had control over the situation, talking about disease, side effects and emotions and putting the focus on the future, and managing life by anticipating death. Family =and friends were a part of patients' coping strategies, but to different extents and in different ways. Diagnosis and treatment for malignant lymphoma brought closeness and distance in social relationships.

CONCLUSION

Patients with malignant lymphoma cope with cancer in different ways in everyday life influenced by their life experiences and life conditions. Further research should focus on cancer patients' coping strategies in a relational perspective, as coping and coping opportunities are embedded in social context and social relationships.

Longitudinal effect of emotional processing on psychological symptoms in women under 50 with breast cancer

Breast cancer is a potential traumatic event associated with psychological symptoms, but few studies have analysed its impact in under-50 women. Emotional processing is a successful function in integrating traumatic experiences. This work analysed the relationship between emotional processing and psychological symptoms during three phases of treatment (before hospitalization, counselling after surgery and adjuvant therapy) in 50 women under the age of 50 with breast cancer. Mixed-effects models tested statistical differences among phases. There were significant differences in symptoms during the treatments: the levels of anxiety decrease from T1 to T3 (0.046), while those of hostility increase (<0.001). Emotional processing is a strong predictor of all symptoms. Clinical implications are discussed.

Modal articulation: The psychological and semiotic functions of modalities in the sensemaking process

Within a semiotic and psychodynamic frame, we present and discuss the psychological construct of modal articulation. By modality, we mean the way a subject organizes the meaning of his/her own experience according to categories of necessity, possibility, opportunity, will, knowledge, permission, and duty. Modality is a relevant topic in some branches of philosophy, logics, linguistics, and semiotics, but there is no systematic discourse about it in psychology. The proposal of this work is to deal with some interesting and promising features of modal categories in the sensemaking process of subjective experience. Modalization is presented as a relevant semiotic organization in each contextual and dynamic sensemaking process in order to perform three functions: (a) connection between affective matrix and subjective experience, (b) mediation between subjective positioning in intersubjective context, and (c) vectorialization of action, namely orienting subjective agency in becoming temporal. Theoretical, methodological, and clinical implications are discussed.