Estrella Durá

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.

Psychometric properties of the Brief Symptom Inventory-18 in a Spanish breast cancer sample

OBJECTIVE The objective of this work was to study the psychometric and structural properties of the Brief Symptom Inventory-18 (BSI-18) in a sample of breast cancer patients (N=175). METHODS Confirmatory factor analyses were conducted. Two models were tested: the theoretical model with the original structure (three-dimensional), and the empirical model (a four-factor structure) obtained through exploratory factor analysis initially performed by the authors of the BSI-18. RESULTS The eligible structure was the original proposal consisting of three dimensions: somatization, depression, and anxiety scores. These measures also showed good internal consistency. CONCLUSION The results of this study support the reliability and structural validity of the BSI-18 as a standardized instrument for screening purposes in breast cancer patients, with the added benefits of simplicity and ease of application.

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.

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.

La teoría del apoyo social y sus implicaciones para el ajuste psicosocial de los enfermos oncológicos

Desde una perspectiva funcionalista los humanos, en su infancia, pronto des-cubren que deben aprender a ser efectivos con la avalancha estimular de su me-dio concreto; al mover sus miembros se dan cuenta de que pueden hacerlo ysiguen repitiendo los movimientos cual reminiscencia, segun diria Allport (1924),del reflejo circular. Desde este preciso instante podria estar ya haciendo posola futura auto-estima del individuo adulto, retomando la corriente de WilliamJames, para quien la autoestima era una funcion de los exitos que pretendemoso a los que aspiramos.Posteriormente, esa necesidad de efectividad y competencia con el medioambiente —para una distincion de ambos terminos vease White (1959)— quese manifiesta en los primeros actos del recien nacido, se traslada no a las cosassino a las personas. El individuo humano descubre que el sentimiento de con-trolabilidad de su medio ambiente le vendra dado en base a su eficacia en lasrelaciones interpersonales con los demas. Y no solo eso, sino que la misma efi-cacia en sus tareas puede verse alterada por la sola presencia de otras personas.Al fin y a la postre este fue el primer experimento de laboratorio en PsicologiaSocial realizado en 1889 por Triplett. Zajonc (1965) y las nuevas aportacionesa su hipotesis de la «mera presencia» realizadas entre otros por Guerin (1986),seguiria con este tipo de trabajos al proponer que la «mera presencia» de colate-rales aumentaba el nivel de «drive» del sujeto y llevaba a la facilitacion social,si bien variables situaciones o de la tarea modulaban tal facilitacion.Definitivamente, la persona humana sigue mostrando esa necesidad secun-daria en terminos de Maslow de «hacerse con los demas», de comunicarse conellos, de «tenerlos» para que nos sostengan y de sentirse queridos. En otras pa-labras, necesitamos tener apoyo social porque en funcion de la amplitud del mis-mo estara el bienestar social e individual del sujeto humano. Intentaremosdesarrollar teoricamente este concepto.

An examination of the psychometric structure of the Multidimensional Pain Inventory in temporomandibular disorder patients: a confirmatory factor analysis

BackgroundThis paper seeks to analyse the psychometric and structural properties of the Multidimensional Pain Inventory (MPI) in a sample of temporomandibular disorder patients.MethodsThe internal consistency of the scales was obtained. Confirmatory Factor Analysis was carried out to test the MPI structure section by section in a sample of 114 temporomandibular disorder patients.ResultsNearly all scales obtained good reliability indexes. The original structure could not be totally confirmed. However, with a few adjustments we obtained a satisfactory structural model of the MPI which was slightly different from the original: certain items and the Self control scale were eliminated; in two cases, two original scales were grouped in one factor, Solicitous and Distracting responses on the one hand, and Social activities and Away from home activities, on the other.ConclusionThe MPI has been demonstrated to be a reliable tool for the assessment of pain in temporomandibular disorder patients. Some divergences to be taken into account have been clarified.

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.