Cristian Ochoa

Posttraumatic growth in cancer: Reality or illusion?

Research in posttraumatic growth (PTG) among cancer patients has been triggered primarily by the inclusion of serious illnesses among the events that can lead to posttraumatic stress disorder (PTSD); increasing survival rates among cancer patients; and, attempts at encouraging a positive psychology that focuses on a patients ability to fight adversity. The difficulties encountered in clearly defining the processes associated with this subjective feeling of growth following recovery raise doubts concerning the real or illusory nature of the phenomenon and its adaptative value. This paper explains why cancer may be different than other traumas and why PTG may interact with this ecology of circumstances in different ways. Difficulty in identifying a single stressor, the internal source of the event, cancer as a future, ongoing and chronic integration threat, and greater perceived control differences between cancer and others traumas. This review brings together the latest studies of PTG in cancer, and focuses in the debate of the real or illusory nature of the PTG and his adaptative value. The ongoing threat, uncertainty and vulnerability associated with cancer are the variables that have been related most consistently with PTG and tend to confuse the relationship between PTG and emotional well-being, too.

Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathologic gambling.

BACKGROUND Impairments in self-regulatory behaviour reflect a deficit in executive functioning and decision-making, as well as higher levels of self-reported impulsivity, and may be involved in the development and maintenance of addictive disorders. We sought to explore the association between self-reported impulsivity and neurocognitive measures, and their association with treatment outcome in pathologic gambling. METHODS We assessed patients with pathologic gambling using executive functioning and decision-making tests and self-report measures of impulsivity. Patients underwent cognitive-behavioural therapy (CBT) for pathologic gambling. RESULTS We included 88 patients (8% women) in our study. High self-reported extravagance was associated with poor performance in the Iowa Gambling Task (IGT)-ABCD version. High impulsiveness, low disorderliness, high exploratory excitability (trend), poor backward block span and poor IGT-EFGH scores (trend) predicted dropout. We observed no self-reported or neurocognitive predictors of relapse or number of treatment sessions attended. LIMITATIONS Most participants were slot-machine gamblers seeking treatment. No follow-up data and no control group were included in the study. The missing sample (i.e., individuals who were recruited and assessed in the pretreatment stage but who chose not to begin treatment) had higher extravagance scores than the final sample. CONCLUSION Neurocognitive reward sensitivity was related to self-reported overspending behaviour. Self-regulatory impairments (especially rash impulsiveness and punishment sensitivity) and executive dysfunction predicted only dropout of CBT in participants with pathologic gambling. Different neurocognitive processes and personality traits might mediate treatment response to psychological therapy of pathologic gambling according to the specific target variable assessed.

Decision-Making Deficits in Pathological Gambling: The Role of Executive Functions, Explicit Knowledge and Impulsivity in Relation to Decisions Made Under Ambiguity and Risk

BACKGROUND A variety of cognitive and emotional processes influence the decision-making deficits observed in pathological gambling (PG). This study investigated the role of immediate/delayed sensitivity to reward and punishment, executive functions, impulsivity and explicit knowledge in relation to decision-making performance on the original Iowa Gambling Task (IGT-ABCD) and a variant (IGT-EFGH). METHODS We assessed 131 consecutive patients with a diagnosis of PG by using executive functioning and decision-making tasks, self-report measures of impulsivity and explicit knowledge. RESULTS The majority of pathological gamblers (PGs) showed deficits in decision-making, characterized mainly by myopia for the future. Decisions made under risk showed different predictors. Performance on the IGT-ABCD for decisions made under risk was predicted by medium and high levels of explicit knowledge of the task, as well as by scores on the Disorderliness subscale and the degree of Stroop interference. By contrast, IGT-EFGH results were only associated with self-report impulsivity measures. CONCLUSIONS Decision making in PG involves distinct patterns of deficits, and the predictors differ depending on the reinforcement schedule. Decisions made under risk on the IGT-ABCD are associated with explicit knowledge, executive functions and impulsivity traits related to conscious awareness and control processes. On the IGT-EFGH, however, only impulsivity traits predict decision making.

Dopamine DRD2/ANKK1 Taq1A and DAT1 VNTR polymorphisms are associated with a cognitive flexibility profile in pathological gamblers

Like drug addiction, pathological gambling (PG) has been associated with impairments in executive functions and alterations in dopaminergic functioning; however, the role of dopamine (DA) in the executive profile of PG remains unclear. The aim of this study was to identify whether the DRD2/ANKK1 Taq1A-rs1800497 and the DAT1-40 bp VNTR polymorphisms are associated with cognitive flexibility (measured by Wisconsin Card Sorting Test (WCST) and Trail Making Test (TMT)) and inhibition response (measured by Stroop Color and Word Test (SCWT)), in a clinical sample of 69 PG patients. Our results showed an association between DA functioning and cognitive flexibility performance. The Taq1A A1+ (A1A2/A1A1) genotype was associated with poorer TMT performance (p < 0.05), while DAT1 9-repeat homozygotes displayed better WCST performance (p < 0.05) than either 10-repeat homozygotes or heterozygotes. We did not find any association between the DRD2 or DAT1 polymorphisms and the inhibition response. These results suggested that pathological gamblers with genetic predispositions toward lower availability of DA and D2 receptor density are at a higher risk of cognitive flexibility difficulties. Future studies should aim to shed more light on the genetic mechanisms underlying the executive profile in PG.

Psychological and clinical correlates of posttraumatic growth in cancer. A systematic and critical review

The objective of this study is to describe major findings on posttraumatic growth (PTG) in cancer, by analyzing its various definitions, assessment tools, and examining its main psychological and clinical correlates.

Positive psychological functioning in breast cancer: An integrative review

This integrative review aimed to analyze the research into positive psychological functioning after breast cancer, and to integrate the most relevant findings relating to sociodemographic, medical and psychosocial factors. Relevant outcomes were identified from electronic databases (Medline, PsycINFO, Web of Science, Scopus, Cochrane, CINAHL, and Wiley Online Library) up to July 2015. A Google search was performed to identify unindexed literature. Dissertations and theses were searched on Proquest Dissertations and Theses, DIALNET and TDX. Selection criteria included empirical studies assessing relationships between breast cancer and positive functioning, without restrictions on type of participants. In total, 134 studies met the inclusion criteria. The sociodemographic, medical, and psychosocial characteristics associated with well-being, posttraumatic growth, finding benefit and meaning were being young, undergoing chemotherapy, and having social support. The last two of these characteristics were time-oriented. The culture of the different samples and positive dispositional characteristics like optimism had an influence on the womens coping styles. Socioeconomic status and level of education were also associated with positive psychological functioning. The perceived impact of breast cancer on patient, as well as the perceived support from significant others can result in better functioning in women with breast cancer. The results highlight that oncology health professionals should take into account not only the individual and medical characteristics, but also the stage of the oncological process and the psychosocial environment of patients in order to promote their positive functioning.

Crecimiento Post-traumático en supervivientes de cáncer y sus otros significativos: ¿Crecimiento vicario o secundario?

espanolLas enfermedades graves como el cancer, aunque generan elevado malestar emocional y estres en los supervivientes y en sus otros significativos, tambien pueden suponer un estimulo en la generacion de crecimiento postraumatico en ambos. Los mecanismos de como se produce este crecimiento postraumatico (vicario vs. secundario) en los otros significativos no se han estudiado. En esta revision se analizan la evidencia y relacion del crecimiento post-traumatico en supervivientes de cancer y en sus otros significativos, principalmente sus parejas, madres y padres, en relacion a estos mecanismos de transmision vicario o secundario. Se concluye que, en general, el crecimiento post-traumatico en los otros significativos es una experiencia vicaria intimamente ligada al crecimiento del superviviente en cancer, aunque ser mujer, madre o sufrir un cancer avanzado facilitan procesos de crecimiento post-traumatico secundario en los otros significativos, que se diferencian del superviviente. EnglishSevere diseases such as cancer although generate high stress and emotional distress in survivors and their significant others, can also be a stimulus to promote posttraumatic growth. The mechanisms of this post-traumatic growth (vicarious vs secondary) in significant others have not been studied. This review examines the evidence and relationship between posttraumatic growth in cancer survivors and their significant others, mainly in their partners and parents, regarding these vicarious or secondary growth transmission mechanisms. We conclude that, in general, posttraumatic growth in significant others is a vicarious experience closely linked to the cancer survivors growth. However, being a woman, mother or suffer an advanced cancer facilitate secondary posttraumatic growth processes insignificant others.

Decision Making Impairment: A Shared Vulnerability in Obesity, Gambling Disorder and Substance Use Disorders?

Introduction Addictions are associated with decision making impairments. The present study explores decision making in Substance use disorder (SUD), Gambling disorder (GD) and Obesity (OB) when assessed by Iowa Gambling Task (IGT) and compares them with healthy controls (HC). Methods For the aims of this study, 591 participants (194 HC, 178 GD, 113 OB, 106 SUD) were assessed according to DSM criteria, completed a sociodemographic interview and conducted the IGT. Results SUD, GD and OB present impaired decision making when compared to the HC in the overall task and task learning, however no differences are found for the overall performance in the IGT among the clinical groups. Results also reveal some specific learning across the task patterns within the clinical groups: OB maintains negative scores until the third set where learning starts but with a less extend to HC, SUD presents an early learning followed by a progressive although slow improvement and GD presents more random choices with no learning. Conclusions Decision making impairments are present in the studied clinical samples and they display individual differences in the task learning. Results can help understanding the underlying mechanisms of OB and addiction behaviors as well as improve current clinical treatments.

Posttraumatic Growth: Challenges from a Cross-Cultural Viewpoint

This chapter examines whether the connection between psychological growth and trauma is universal or linked to a specific cultural viewpoint. The concept of post-traumatic growth (PTG) is examined in relation to psychological distress and well-being in various cultural settings. Finally, recommendations on how to stimulate growth processes through specific psychological interventions are provided.

Positive psychotherapy for distressed cancer survivors: Posttraumatic growth facilitation reduces posttraumatic stress

Background/Objective There is increasing evidence that positive life changes, such as posttraumatic growth (PTG), can result from the experience of coping with cancer. However, no interventions have been specifically designed to facilitate the development of PTG in cancer. In this article, we describe and assess the results of Positive Psychotherapy for Cancer (PPC) survivors. It aims to facilitate PTG as a way of achieving significant reductions in the symptoms of emotional distress and posttraumatic stress. In addition, the corroboration of this PTG facilitation is assessed using interpersonal indicators. Method: We allocated 126 consecutive survivors of cancer with high levels of emotional distress and who were seeking psychological support to either an experimental group (PPC) or a waiting list group. Results: The PPC group obtained significantly better results after treatment than the control group, showing reduced distress, decreased posttraumatic symptoms, and increased PTG. The benefits were maintained at 3 and 12 months’ follow-up. Participants’ PTG was correlated to the PTG that their significant others attributed to them, corroborating PTG facilitation. Conclusions: PPC appears to promote significant long-term PTG and can reduce emotional distress and posttraumatic stress in cancer survivors. In addition, PTG facilitation induced by PPC is corroborated by significant others.