Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients

BACKGROUND:
A cancer diagnosis may lead to significant psychological distress in up to 75% of cases. There is a lack of clarity about the most effective ways to address this psychological distress.
OBJECTIVES:
To assess the effects of psychosocial interventions to improve quality of life (QoL) and general psychological distress in the 12-month phase following an initial cancer diagnosis.
SEARCH METHODS:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE, EMBASE, and PsycINFO up to January 2011. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. Electronic searches were carried out across all primary sources of peer-reviewed publications using detailed criteria. No language restrictions were imposed.
SELECTION CRITERIA:
Randomised controlled trials of psychosocial interventions involving interpersonal dialogue between a 'trained helper' and individual newly diagnosed cancer patients were selected. Only trials measuring QoL and general psychological distress were included. Trials involving a combination of pharmacological therapy and interpersonal dialogue were excluded, as were trials involving couples, family members or group formats.
DATA COLLECTION AND ANALYSIS:
Trial data were examined and selected by two authors in pairs with mediation from a third author where required. Where possible, outcome data were extracted for combining in a meta-analyses. Continuous outcomes were compared using standardised mean differences and 95% confidence intervals, using a random-effects model. The primary outcome, QoL, was examined in subgroups by outcome measurement, cancer site, theoretical basis for intervention, mode of delivery and discipline of trained helper. The secondary outcome, general psychological distress (including anxiety and depression), was examined according to specified outcome measures.
MAIN RESULTS:
A total of 3309 records were identified, examined and the trials subjected to selection criteria; 30 trials were included in the review. No significant effects were observed for QoL at 6-month follow up (in 9 studies, SMD 0.11; 95% CI -0.00 to 0.22); however, a small improvement in QoL was observed when QoL was measured using cancer-specific measures (in 6 studies, SMD 0.16; 95% CI 0.02 to 0.30). General psychological distress as assessed by 'mood measures' improved also (in 8 studies, SMD - 0.81; 95% CI -1.44 to - 0.18), but no significant effect was observed when measures of depression or anxiety were used to assess distress (in 6 studies, depression SMD 0.12; 95% CI -0.07 to 0.31; in 4 studies, anxiety SMD 0.05; 95% CI -0.13 to 0.22). Psychoeducational and nurse-delivered interventions that were administered face to face and by telephone with breast cancer patients produced small positive significant effects on QoL (in 2 studies, SMD 0.23; 95% CI 0.04 to 0.43).
AUTHORS' CONCLUSIONS:
The significant variation that was observed across participants, mode of delivery, discipline of 'trained helper' and intervention content makes it difficult to arrive at a firm conclusion regarding the effectiveness of psychosocial interventions for cancer patients. It can be tentatively concluded that nurse-delivered interventions comprising information combined with supportive attention may have a beneficial impact on mood in an undifferentiated population of newly diagnosed cancer patients.

Impact of the Roots of Empathy Programme on Social-Emotional Learning: A Randomized Controlled Trial

Roots of Empathy (ROE) is a universal, school-based social and emotional learning programme aimed at increasing prosocial behaviour and reducing difficult behaviour. This paper reports the findings of a cluster randomized controlled trial of the effects of ROE on 8-9 year old children. 74 schools and 1,181 children took part. The findings provide evidence that ROE is effective in increasing prosocial behaviour (g=+.20, p=.043) and some potential evidence that it may reduce difficult behaviour (g=-.15, p=.070). While ROE was found to lead to improvements in positive behaviour, these were not associated with improvements in empathy or other social and emotional learning outcomes.

Looking behaviour and preference for artworks: The role of emotional valence and location

The position of an item influences its evaluation, with research consistently finding that items occupying central locations are preferred and have a higher subjective value. The current study investigated whether this centre-stage effect (CSE) is a result of bottom-up gaze allocation to the central item, and whether it is affected by item valence. Participants (n=50) were presented with three images of artistic paintings in a row and asked to choose the image they preferred. Eye movements were recorded for a subset of participants (n=22). On each trial the three artworks were either similar but different, or were identical and with positive valence, or were identical and with negative valence. The results showed a centre-stage effect, with artworks in the centre of the row preferred, but only when they were identical and of positive valence. Significantly greater gaze allocation to the central and left artwork was not mirrored by equivalent increases in preference choices. Regression analyses showed that when the artworks were positive and identical the participants’ last fixation predicted preference for the central art-work, whereas the fixation duration predicted preference if the images were different. Overall the result showed that item valence, rather than level of gaze allocation, influences the CSE, which is incompatible with the bottom-up gaze explanation. We propose that the centre stage heuristic, which specifies that the best items are in the middle, is able to explain these findings and the centre-stage effect.

Emotional Responses to Disfigured Faces: The Influences of Perceived Anonymity, Empathy, and Disgust Sensitivity

Two experiments investigated self-reported emotional reactions to photographs of people with attractive, unattractive or structurally disfigured faces. In Experiment 1 participants viewing disfigured faces reported raised levels of sorrow and curiosity but not raised levels of negative emotions. In Experiment 2 there was more negative emotion and less positive emotion reported under conditions of relatively high anonymity, compared to low anonymity, specific to disfigured faces, suggesting that self-reports are influenced by social desirability. Trait empathy was associated with sorrow and negative emotions when viewing disfigured faces. Disgust sensitivity was associated with negative emotions and inversely associated with positive emotions.

Towards a positive cross-cultural lexicography: Enriching our emotional landscape through 216 ‘untranslatable’ words pertaining to well-being

Although much attention has been paid to culture-specific psychopathologies, there have been no comparable attempts to chart positive mental states that may be particular to certain cultures. This paper outlines the beginnings of a positive cross-cultural lexicography of ‘untranslatable’ words pertaining to wellbeing, culled from across the world’s languages. A quasi-systematic search uncovered 216 such terms. Using grounded theory, these words were organised into three categories: feelings (comprising positive and complex feelings); relationships (comprising intimacy and pro-sociality); and character (comprising personal resources and spirituality). The paper has two main aims. First, it aims to provide a window onto cultural differences in constructions of wellbeing, thereby enriching our understanding of wellbeing. Second, a more ambitious aim is that this lexicon may help expand the emotional vocabulary of English speakers (and indeed speakers of all languages), and consequently enrich their experiences of wellbeing. The paper concludes by setting out a research agenda to pursue these aims further.

Alexithymia, emotional processing and psychotherapy : a mixed methods research

Tese de doutoramento, Psicologia (Psicologia Clínica), Universidade de Lisboa, Faculdade de Psicologia, 2014

Identity, Well-being and Effectiveness: the Emotional Contexts of Teaching

This paper draws on findings from a four‐year longitudinal research project, commissioned by the Department for Education and Skills (DfES), which investigated Variations in Teachers’ Work, Lives and Effectiveness (VITAE). Drawing on data gathered from 300 teachers working in 100 primary and secondary schools in England, the research identified associations between commitment and effectiveness (perceived and in terms of pupil attainment) and found that there were more, and less, effective teachers in each of six professional life phases. It found that teachers in each of these phases experienced a number of different scenarios that challenged their abilities to sustain their commitment (i.e. remain resilient). This paper discusses how these impact, positively and negatively, on teachers’ capacities for sustaining their initial commitment and associations between identity, well‐being and effectiveness. It finds that teacher identities are neither intrinsically stable nor intrinsically fragmented, but that they can be more, or less, stable and more or less fragmented at different times and in different ways according to the influence of the interaction of a number of personal, professional and situated factors. The extent to which teachers are able to and are supported in managing the scenarios they experience will determine their sense of effectiveness.

A comparative study of complex multiple-band noise-shaping sigma-delta modulators for multi-tone input signals

This paper presents a comparative study of complex single-bit and multi-bit sigma-delta modulators that are capable of providing concurrent multiple-band noise-shaping for multi-tone narrow-band input signals. The concepts applied for the three design methodologies are based on the noise transfer functions of complex comb, complex slink and complex multi-notch filters.

Men’s strategies for preserving emotional well-being in advanced prostate cancer: an interpretative phenomenological analysis

Objective This study explores men with advanced prostate cancers’ own practices for promoting and maintaining emotional well-being using Interpretative Phenomenological Analysis. Design Five men with advanced prostate cancer participated in face-to-face, semi-structured, in-depth interviews. Results Within rich narratives of lost and regained well-being, two super-ordinate themes emerged – ‘living with an imminent and uncertain death’ and ‘holding on to life.’ Well-being was threatened by reduced sense of the future, isolation and uncertainty. Yet, the men pursued well-being by managing their emotions, striving for the future whilst enjoying life in the present, taking care of their families and renegotiating purpose. Running through participant’s accounts was a preference for taking action and problem-solving. Sense of purpose, social connectedness and life-engagement were revealed as concepts central to improving well-being, indicating areas which practitioners could explore with men to help them re-establish personal goals and life-purpose. Conclusions The findings also add weight to the evidence base for the potential value of psychological interventions such as cognitive behaviour therapy and mindfulness in men with prostate cancer.

Exploring the consumer decision journey and online shoping experience through an emotional prespective

Traditional consumer decision-making models have long used quantitative research to address a link between emotional and rational behavior. However, little qualitative research has been conducted in the area of online shopping as an end-to-end experience. This study aims to provide a detailed phenomenological account of consumers’ online shopping experience and extend Mckinsey & Companys’s consumer decision journey model from an emotional perspective. Six semi-structured interviews and a focus group of nine people are analyzed using Interpretive Phenomenology Analysis and five superordinate themes emerged from the results: emotional experience, empathy and encouragement, in relation to brand preference, emotional encounters in relation to consumer satisfaction and emotional exchange and relationship with a company or brand. A model interrelating these themes is then introduced to visually represent the emotional essence of a large online purchase. This study promises to be applicable as a descriptive, and perhaps, better predictive report for understanding the complex consumer decision-making process as it relates to online consumer behavior. Future research topics are also identified.

Cognitive and emotional effects of carotid stenosis.

PRINCIPLES: Patients with carotid artery stenosis (CAS) are at risk of ipsilateral stroke and chronic compromise of cerebral blood flow. It is under debate whether the hypo-perfusion or embolism in CAS is directly related to cognitive impairment. Alternatively, CAS may be a marker for underlying risk factors, which themselves influence cognition. We aimed to determine cognitive performance level and the emotional state of patients with CAS. We hypo-thesised that patients with high grade stenosis, bilateral stenosis, symptomatic patients and/or those with relevant risk factors would suffer impairment of their cognitive performance and emotional state. METHODS: A total of 68 patients with CAS of ≥70% were included in a prospective exploratory study design. All patients underwent structured assessment of executive functions, language, verbal and visual memory, motor speed, anxiety and depression. RESULTS: Significantly more patients with CAS showed cognitive impairments (executive functions, word production, verbal and visual memory, motor speed) and anxiety than expected in a normative sample. Bilateral and symptomatic stenosis was associated with slower processing speed. Cognitive performance and anxiety level were not influenced by the side and the degree of stenosis or the presence of collaterals. Factors associated with less co-gnitive impairment included higher education level, female gender, ambidexterity and treated hypercholesterolemia. CONCLUSIONS: Cognitive impairment and increased level of anxiety are frequent in patients with carotid stenosis. The lack of a correlation between cognitive functioning and degree of stenosis or the presence of collaterals, challenges the view that CAS per se leads to cognitive impairment.