Acute stress trajectories 1 year after a breast cancer diagnosis.

PURPOSE: The purpose of this study was to evaluate the longitudinal trajectories of acute stress reactions over the course of diagnosis, treatment, and follow-up assessments in a group of non-metastatic breast cancer patients during five different moments of the illness process, and to identify psychological predictors of the trajectories. METHODS: The sample was formed by 102 non-metastatic breast cancer patients treated with adjuvant chemotherapy. Latent growth mixture models (LGMM) were used to identify latent classes, and we used multinomial logistic regression in a conditional model to examine predictors to differentiate between trajectories. RESULTS: We identified four different groups according to their trajectories: (1) a resilient group, (44.5 %); (2) a mild acute stress group, (40.6 %); (3) a delayed-recovery group (11.9 %); and (4) a chronic acute stress group (2.9 %). Moreover, anxious preoccupation showed the strongest significant effects in predicting each class, whereas cognitive avoidance and type C personality had moderate effects for participants in the mild acute stress group. CONCLUSIONS: This study demonstrates that the majority of breast cancer patients in our study were resilient, with only a small percentage showing chronic acute stress. Because coping strategies, specifically anxious preoccupation, and not more stable variables played a main role in the prediction of acute stress trajectories, future preventive interventions should center in promoting more adaptive coping strategies in breast cancer patients.

Improving the Diagnostic Accuracy of the Distress Thermometer: A Potential Role for the Impact Thermometer.

CONTEXT: Screening for and management of distress in clinical practice is an important issue in the field of psycho-oncology. The Distress Thermometer (DT) is a common screening tool, but other methods recently have been proposed, with the aim of improving its diagnostic accuracy. OBJECTIVES: To investigate the diagnostic accuracy of the DT alone and combined with the Impact Thermometer (IT), via the use of two possible combination methods. METHODS: A heterogeneous sample of 385 adult patients with cancer completed the DT, the IT, and the Brief Symptom Inventory-18. RESULTS: The results of the DT were comparable with those found in previous studies, indicating that the DT was adequate for "screening" but had limited value for "case finding." The DT and the IT combined (summed or paired scores) showed minor differences in accuracy indexes compared with the DT alone. CONCLUSION: The results of this study suggest that the addition of the IT to the DT failed to improve its accuracy for identifying distress.

Posttraumatic stress symptoms in breast cancer patients: temporal evolution, predictors, and mediation.

This study (N = 102 women) evaluated the time course of posttraumatic stress symptomatology (PTSS) at different stages of nonmetastastic cancer diagnosis and treatment: during treatment, at the end of treatment, and at a 6-12 months follow-up. We also assessed the contribution of demographic, trait, and state predictors to PTSS, and coping processes as proximal mediators of the relation between Type C personality and PTSS. Results indicated that PTSS remained constant across all phases. There were significant correlations (range = .28 to .81) between PTSS and psychosocial variables and age, but not with other sociodemographic or medical factors. A linear growth curve model showed that hopelessness/helplessness (B = 1.45) and Type C personality (B = 1.40) were the best predictors of PTSD symptomatology, followed by trait dissociation (B = 0.55), and the coping strategies of anxious preoccupation (B = 1.20), cognitive avoidance (B = 0.91), and symptoms of acute stress disorder (B = 0.19). A mediation model showed that the coping strategies of anxious preoccupation, cognitive avoidance, and helplessness/hopelessness mediated the relationship between Type C personality and PTSS during treatment, posttreatment, and follow-up. These results clarify the contribution of different predictors of PTSS and can help develop prevention programs.

The Distress Thermometer in Spanish cancer patients: convergent validity and diagnostic accuracy.

PURPOSE: International organizations such as National Comprehensive Cancer Network and NICE recommend implementation of routine screening programs for detecting and managing psychosocial distress among cancer patients. The selection of an adequate screening tool is crucial to the effectiveness of these programs. The present study examines the emotional symptomatology captured by the Distress Thermometer (DT) and its accuracy and validity as a screening tool in cancer. It also explores the possible discrepancy between patient distress and the use of psycho-oncology resources. METHODS: A heterogeneous sample of 962 adult cancer patients completed the DT, the Problem List (PL), the Brief Symptom Inventory-18 (BSI-18), and the Psychosocial Questionnaire. RESULTS: The DT was significantly correlated with BSI-18 symptoms and the emotional problems listed on the PL. Receiver Operating Characteristic analysis showed good diagnostic accuracy for the DT (area under the curve = .82, 95 %CI [.79-.85]). For a selected DT cutoff of 5, standard measures (sensitivity = 90 %, specificity = 64 %, predictive positive value = 35 %, and negative predictive value = 97 %) and Clinical Utility Indexes (utility index negative = .62 and utility index positive = .32) indicated that the DT was adequate for "screening" while it was limited for "case finding." Finally, 81.30 % of patients with clinical distress had not sought or were not receiving professional psychosocial support at the time of the study. CONCLUSION: The DT is appropriate for use as a rapid screening instrument for cancer patients in a Spanish population because it assesses a broad concept of distress including both anxiety and depression symptoms. The diagnostic accuracy of the DT could be improved with minor proposed modifications to the DT and the inclusion of nonemotional ultrashort measures.

Enhancing the efficacy of treatment for temporomandibular patients with muscular diagnosis through cognitive-behavioral intervention, including hypnosis: a randomized study.

OBJECTIVE: This study evaluated the efficacy of a cognitive-behavioral therapy (CBT), including hypnosis, in patients with temporomandibular disorders (TMDs) with muscular diagnosis. STUDY DESIGN: Seventy-two patients (65 women and 7 men with an average age of 39 years) were selected according to the Research Diagnostic Criteria for TMD, and assigned to the experimental group (n = 41), receiving the 6-session CBT program, and the control group (n = 31). All patients received conservative standard treatment for TMD. The assessment included pain variables and psychologic distress. RESULTS: There were significant differences between the groups, the experimental group showing a higher improvement in the variables evaluated. Specifically, 90% of the patients under CBT reported a significant reduction in frequency of pain and 70% in emotional distress. The improvement was stable over time, with no significant differences between posttreatment and 9-month follow-up. CONCLUSIONS: CBT, including hypnosis, significantly improved conservative standard treatment outcome in TMD patients.

A longitudinal study of psychosocial distress in breast cancer: prevalence and risk factors.

This longitudinal study was conducted among 102 women with non-metastasic breast cancer to identify the time evolution and prevalence of distress at specific times through diagnosis and treatment of disease: preliminary diagnosis, surgery, definitive diagnosis and chemotherapy. Additionally, the study aimed to examine the role of demographic, medical and psychosocial factors on distress. The results indicated that prevalence of distress was higher at initial diagnosis (25%) than the following time points (approximately 17%). The differences inter-individuals in the levels of distress were observed over the four assessments. No relation between distress and demographic and medical factors was found. However, psychosocial aspects were significant risk factors. Patterns of emotional suppression and specific coping responses like helplessness/hopelessness, anxious preoccupation, cognitive avoidance and fatalism were positively related to distress, whereas fighting spirit and perceived social support showed a protective role. Moreover, helplessness/hopelessness and anxious preoccupation jointly predicted 75% of cases and 98% non-cases of distress. Finally, a mediational model between emotional suppression and distress through helplessness/hopelessness was tested. Results support the necessity of routine distress screening all through the illness. Implications of data for psychosocial interventions with breast cancer patients are highlighted.

Emotional suppression and breast cancer: validation research on the Spanish Adaptation of the Courtauld Emotional Control Scale (CECS).

Emotional suppression has played an important role in the research on psychosocial factors related to cancer. It has been argued to be an important psychological factor predicting worse psychosocial adjustment in people with cancer and it may mediate health outcomes. The reference instrument in the research on emotional suppression is the Courtauld Emotional Control Scale (CECS). The present study analysed construct validity of a new Spanish adaptation of the CECS in a sample of 175 breast cancer patients. The results confirmed the proposal by Watson and Greer claiming that the CECS is composed of three subscales that measure different dimensions, but not independent, from emotional control. The present Spanish version of the CECS showed high internal consistency in each subseale as well as the total score. According to Derogatis (BSI-18) criteria, emotional suppression predicts clinically significant distress. In short, our results support the reliability, validity and utility of this Spanish adaptation of the CECS in clinical and research settings.

Emotional suppression and breast cancer: validation research on the spanish adaptation of the Courtauld Emotional Control Scale (CECS)

Emotional suppression has played an important role in the research on psychosocial factors related to cancer. It has been argued to be an important psychological factor predicting worse psychosocial adjustment in people with cancer and it may mediate health outcomes. The reference instrument in the research on emotional suppression is the Courtauld Emotional Control Scale (CECS). The present study analysed construct validity of a new Spanish adaptation of the CECS in a sample of 175 breast cancer patients. The results confirmed the proposal by Watson and Greer claiming that the CECS is composed of three subscales that measure different dimensions, but not independent, from emotional control. The present Spanish version of the CECS showed high internal consistency in each subscale as well as the total score. According to Derogatis (BSI-18) criteria, emotional suppression predicts clinically significant distress. In short, our results support the reliability, validity and utility of this Spanish adaptation of the CECS in clinical and research settings (AU)

La supresión emocional ha jugado un papel importante en la investigación de los factores psicosociales relacionados con el cáncer. Se ha discutido que es un importante factor psicológico que predice un peor ajuste psicosocial en las personas que sufren cáncer y que puede mediar los resultados médicos. El instrumento de referencia en la investigación acerca de la supresión emocional es el Courtauld Emotional Control Scale (CECS). El presente estudio analiza la validez de constructo de una nueva adaptación española del CECS en una muestra de 175 pacientes con cáncer de mama. Los resultados confirman la estructura propuesta por Watson y Greer para el instrumento, compuesta de tres subescalas que evalúan distintas dimensiones no independientes, del control emocional. La presente versión española del CECS mostró una elevada consistencia interna de cada una de las subescalas y de la puntuación total. Además la supresión emocional predice el distrés clínico significativo, según criterios de Derogatis (BSI-18). En resumen, nuestros resultados respaldan la fiabilidad, validez y utilidad de la adaptación española del CECS en contextos clínicos y de investigación (AU)

Psychometric properties of the Brief Symptoms Inventory-18 (Bsi-18) in a Spanish sample of outpatients with psychiatric disorders.

This study analyzes the psychometric and structural properties of the BSI-18 in a sample of Spanish outpatients with psychiatric disorders (N = 200), with three basic objectives: (a) to study the structural validity of the instrument; (b) to analyse reliability (internal consistency and test-retest stability) and validity (convergent and discriminant) of the instrument, and (c) to evaluate sensitivity to change in a therapeutic context. Using confirmatory factor analysis, two models were tested: the three-dimensional theoretical model proposed by its authors, and the empirical four-factor model obtained by the same authors through exploratory factor analysis. Our results showed that the best structure was a four-dimensional model, with the General Distress index and Somatization, Depression, General Anxiety and Panic scores. These four scales showed good internal consistency, test-retest reliability, validity and sensitivity to therapeutic change. The BSI-18 has been shown to be a reliable and useful tool for psychiatric assessment of patients, with the added advantage provided by its simplicity and ease of application.

Psychometric properties of the Brief Symptoms Inventory-18 (BSI-18) in a Spanish sample of outpatients with psychiatric disorders / Propiedades psicométricas del Brief Symptoms Inventory 18 (BSI-18) en una muestra española de pacientes ambulatorios con trastornos psiquiátricos

This study analyzes the psychometric and structural properties of the BSI-18 in a sample of Spanish outpatients with psychiatric disorders (N= 200), with three basic objectives: (a) to study the structural validity of the instrument; (b) to analyse reliability (internal consistency and test-retest stability) and validity (convergent and discriminant) of the instrument, and (c) to evaluate sensitivity to change in a therapeutic context. Using confirmatory factor analysis, two models were tested: the three-dimensional theoretical model proposed by its authors, and the empirical four-factor model obtained by the same authors through exploratory factor analysis. Our results showed that the best structure was a four-dimensional model, with the General Distress index and Somatization, Depression, General Anxiety and Panic scores. These four scales showed good internal consistency, test-retest reliability, validity and sensitivity to therapeutic change. The BSI-18 has been shown to be a reliable and useful tool for psychiatric assessment of patients, with the added advantage provided by its simplicity and ease of application

Este trabajo analiza las propiedades psicométricas y estructurales del BSI-18 en una muestra española de pacientes ambulatorios con trastornos psiquiátricos (N= 200) con tres objetivos: (i) estudiar la validez estructural del mismo; (ii) analizar su fiabilidad (consistencia interna y estabilidad test-retest) y validez (convergente y discriminante); y (iii) evaluar su sensibilidad al cambio en el contexto terapéutico. Utilizando análisis factorial confirmatorio, se pusieron a prueba dos modelos estructurales: el modelo trifactorial propuesto teóricamente por los autores del instrumento, y el modelo empírico obtenido por los mismos a través de un análisis factorial exploratorio que arrojó cuatro factores. Nuestros resultados mostraron que la estructura óptima era un modelo de cuatro dimensiones que diferencia entre Somatización, Depresión, Ansiedad general y Pánico. Estas cuatro escalas mostraron índices adecuados de consistencia interna, fiabilidad test-retest, validez convergente y discriminante, y sensibilidad al cambio terapéutico. El BSI-18 ha mostrado ser un instrumento fiable y válido para la evaluación de pacientes con trastornos psiquiátricos, con la ventaja adicional de su simplicidad y brevedad de aplicación

Multidimensional approach to the differences between muscular and articular temporomandibular patients: coping, distress, and pain characteristics.

OBJECTIVE: This study analyzes the differences in psychological variables and symptomatology between temporomandibular disorder diagnosis subgroups. STUDY DESIGN: The sample included 114 temporomandibular disorder patients that were evaluated in coping, distress, and temporomandibular characteristics. Diagnostic muscular (n = 58) and articular (n = 56) subgroups were compared in these variables through a MANCOVA. RESULTS: Muscular patients show a higher level of general distress, specifically in the anxiety and somatization subscales and a more active coping style, with a tendency of a minor use of humor and a higher number of parafunctional habits, specifically, biting nails, hangnails, and lips. CONCLUSION: We discuss the differences found in order to design the targets of the psychological intervention of temporomandibular patients.

Los factores psicológicos en el trastorno temporomandibular / Psychological factors intemporomandibular disorder

Este trabajo analiza el estado actual de la investigación sobre el papel de los factores psicológicos en los trastornos temporomandibulares. Se considera la problemática asociada a la manifestación clínica y criterios diagnósticos de estos trastornos, así como los diferentes planteamientos en torno a su etiología. El artículo incluye los principales hallazgos encontrados sobre la contribución de los factores psicológicos en los trastornos temporomandibulares, describiendo los problemas metodológicos en este campo. Entre estos resultados se analiza la evidencia respecto a la hipótesis psicofisiológica -que relaciona el estrés con la etiología de los trastornos temporomandibulares-; se destaca la existencia de mayores niveles de psicopatología en pacientes temporomandibulares, fundamentalmente en el subtipo muscular; y, finalmente, se considera la contribución de los factores psicológicos cuando los trastornos temporomandibulares se analizan desde la perspectiva del dolor crónico

This paper discusses the current situation of the research about the role of psychological factors in temporomandibular disorders. It is considered the controversy related to the clinical manifestation and diagnostic criteria of these disorders and the different approaches to their etiology. The article includes the more important results found in the research about the role of psychological factors in temporomandibular disorders are commented, describing the metodological problems in this field. Between these results, we analyze the evidence regarding to the psycophysiological hypothesis -that relates stress to the temporomandibular disorders etiology-; it is pointed out the existence of higher levels of psychopatology in temporomandibular disorder patients, specially in the muscular subtype; and finally, it is considered the contribution of psychological factors when the temporomandibular disorder is analyzed from the chronic pain approach