Jane Austin

Randomized Clinical Trial of Telephone-Administered Cognitive-Behavioral Therapy to Reduce Post-Traumatic Stress Disorder and Distress Symptoms After Hematopoietic Stem-Cell Transplantation

PURPOSE A significant number of survivors of hematopoietic stem-cell transplantation (HSCT) report enduring adverse effects of treatment, including illness-related post-traumatic stress disorder (PTSD) symptoms and general distress. We report results of a randomized clinical trial that tested the effects of a 10-session, telephone-administered cognitive-behavioral therapy (CBT) intervention on PTSD, depression, and distress symptoms. METHODS Survivors who had undergone HSCT 1 to 3 years earlier (N = 408) were assessed for study eligibility. Those who met study eligibility criteria (n = 89) completed a baseline assessment that included a clinical interview and self-report measures of PTSD symptoms (the primary outcome) and depression and general distress (the secondary outcomes). Next, they were randomly assigned to CBT or an assessment-only condition. Survivors in the CBT group completed 10 individual telephone-based CBT sessions (T-CBT) that included strategies to reduce PTSD symptoms, depression, and general distress. Follow-up assessments occurred at 6, 9, and 12 months after the baseline assessment. RESULTS Linear mixed-model analyses revealed that, compared with HSCT survivors in the assessment-only condition, survivors who completed T-CBT reported fewer illness-related PTSD symptoms, including less avoidance (P < .001) and fewer intrusive thoughts (P < .05) as well as less general distress and fewer depressive symptoms (P < .05) even after controlling for potential demographic and medical covariates. These results were consistent across the three follow-up assessments. CONCLUSION A brief, telephone-administered CBT intervention developed for HSCT survivors is an efficacious treatment for reducing illness-related PTSD symptoms and general distress.

Effectiveness of Partner Social Support Predicts Enduring Psychological Distress after Hematopoietic Stem Cell Transplantation

OBJECTIVE Hematopoietic stem cell transplant (HSCT) survivors who are 1 to 3 years posttransplant are challenged by the need to resume valued social roles and activities--a task that may be complicated by enduring transplant-related psychological distress common in this patient population. The present study investigated whether transplant survivors who receive adequate social support from their spouse or intimate partner experience lower distress. METHOD Effects of receiving a greater quantity of partner support (a common approach to studying enacted support) were compared with effects of receiving more effective partner support (i.e., support that more closely matches their needs in terms of its quantity and quality). Men and women (N = 230) who were 1 to 3 years posttransplant completed measures of partner support quantity (Manne & Schnoll, 2001), partner social support effectiveness (Rini & Dunkel Schetter, 2010), and psychological distress (Brief Symptom Inventory; Derogatis & Spencer, 1982). Potential medical and sociodemographic confounds were controlled in analyses. RESULTS As hypothesized, survivors reported less distress when they received more effective partner support (p < .001). Quantity of partner support was not associated with distress (p = .23). An interaction revealed that when partner support was effective, the quantity of support survivors received was not associated with their distress (p = .90); however, when partner support was ineffective, receiving a greater quantity of partner support was associated with substantially elevated distress (p = .002). CONCLUSIONS Findings suggest that clinical approaches to addressing or preventing enduring distress after HSCT should target features of partner support related to its appraised effectiveness.

Peer Mentoring and Survivors' Stories for Cancer Patients: Positive Effects and Some Cautionary Notes

Providing patients with adequate information produces better medical outcomes, less distress, higher quality of life, and better preparation for active involvement in treatment—benefits that have energized research on the effective delivery of information to patients. For the most part, this research has focused on information and statistics relevant to treatment and prognosis. However, patients are increasingly coming into contact with another form of information about which little is known —namely, information describing the experiences of fellow cancer patients, or experiential information. For instance, the Internet makes this information available through patient-oriented chat rooms, bulletin boards, and a growing number of popular Web sites featuring survivors’ stories, case studies, and testimonials. Apart from the Internet, patients learn about other patients’ experiences in the popular media and through peer mentoring or buddy programs made available by treatment centers or cancer organizations. These programs enable patients to receive encouragement, support, and guidance from people with first-hand knowledge of the difficulties and fears they may be experiencing. Peer mentors may, or may not, be formally trained and are free to share any aspect of their experience they deem helpful, including information about their treatment decisions, effects of treatment, coping strategies, and recovery obstacles. In so doing, they attempt to communicate both factual information and information about normal or desirable ways to respond to cancer. Generally speaking, patients like getting experiential information, and many former patients enjoy providing it. At the same time, the informational content of peer mentoring and survivors’ stories has the potential to influence patients in significant ways. Yet little is known about how patients use this information or how it affects them. When does it give them hope, and when does it frighten them? Does it facilitate, or complicate, decision making? Under what circumstances is it helpful versus harmful? To begin investigating the answers to such questions, cancer patients’ responses to interview questions assessing how they communicated their thoughts and emotions during treatment were analyzed. Participants consisted of 20 men and 10 women completing a screening protocol for a multisite trial testing a psychological intervention for hematopoietic stem-cell transplant (HSCT) survivors. All study procedures were approved by the institutional review boards at the study sites, and patients provided signed informed consent. All patients had undergone HSCT 1 to 3 years earlier to treat hematologic malignancies such as multiple myeloma, lymphoma, and leukemia, and all were English speakers who were at least 18 years old at recruitment and at least 16 years old at transplantation. They were, on average, 54 years old, married (n 25), white (n 25), and well-educated (22 had college or graduate degrees). Most (n 25) reported an annual household income of more than

Pre-bereavement meaning and post-bereavement distress in mothers of children who underwent haematopoietic stem cell transplantation

80,000. Content analysis of their responses to interview questions identified 10 functions of communication. Of the four most commonly mentioned functions, three prominently featured contact with other patients and/or exposure to information about their experiences: preparatory coping, social comparison, and negative effects. This article focuses on results involving these three functions of communication because of their relevance for understanding the effects of experiential information on cancer patients.

Social correlates of distress following hematopoietic stem cell transplantation: Exploring the role of loneliness and cognitive processing

OBJECTIVES The purpose of this study was to explore the association of meaning-making with psychological adjustment to bereavement among mothers of children who had undergone haematopoietic stem cell transplantation (HSCT). DESIGN A prospective research design was used. Regression analyses were conducted to determine the relations between pre-bereavement variables (distress, searching for meaning, and finding meaning) and distress post-bereavement. METHODS Thirty-five mothers of children who had undergone HSCT were interviewed at the time of their childs HSCT and 3 months post-bereavement. RESULTS Mothers who reported searching for meaning at HSCT reported greater post-bereavement distress, and mothers who reported finding meaning at HSCT reported less post-bereavement distress. Distress at HSCT and the number of days between the time of death and the post-bereavement time point were also found to be significant predictors of post-bereavement distress. CONCLUSIONS This study provides partial support for the role of meaning in adjustment to loss.

Harnessing Benefits of Helping Others: A Randomized Controlled Trial Testing Expressive Helping to Address Survivorship Problems After Hematopoietic Stem Cell Transplant

This study investigated whether loneliness and cognitive processing explain the influence of negative (social constraints) and positive (emotional support) relationship qualities on cancer survivors’ distress. Participants were 195 cancer survivors who had undergone hematopoietic stem cell transplantation. Path analysis supported the hypothesis that loneliness and cognitive processing would mediate the association between social constraints and distress. Only loneliness mediated the association between emotional support and distress – an indirect effect significant only when support came from family and friends rather than a partner. Findings suggest that addressing social constraints may enhance cancer survivors’ adjustment.

Perceived partner critical and avoidant behaviors as predictors of anxious and depressive symptoms among mothers of children undergoing hemopaietic stem cell transplantation

OBJECTIVE Prior research supports the hypothesis that cancer survivors who help others face treatment experience a range of psychosocial and health-related benefits as a result of peer helping. This study investigates an expressive helping (EH) intervention designed to harness those benefits by targeting survivorship problems among cancer survivors treated with hematopoietic stem cell transplant. EH includes two components: (a) emotionally expressive writing (EW; writing ones deepest thoughts and feelings about the transplant experience in a series of brief, structured writing sessions) followed by (b) peer helping (PH; helping other people prepare for transplant by sharing ones own transplant experiences along with advice and encouragement through a written narrative). METHOD EH was compared with neutral writing (NW), EW (without PH), and PH (without EW) in a 4-arm randomized controlled trial in which survivors completed baseline measures, 4 structured writing exercises (with instructions depending on randomization), and postintervention measures including validated measures of general psychological distress, physical symptoms, and health-related quality of life (HRQOL). RESULTS Among survivors with moderate-severe survivorship problems, EH reduced distress (compared with NW and PH; ps < .05) and improved physical symptoms (compared with NW, PH, and EW; ps < .002) and HRQOL (compared with NW; p = .02). CONCLUSIONS Peer helping through writing benefits transplant survivors with moderate-severe survivorship problems, but only if they have first completed expressive writing.

I Keep my Problems to Myself: Negative Social Network Orientation, Social Resources, and Health-Related Quality of Life in Cancer Survivors

This prospective study examined the role of perceived partner criticism and avoidance in the anxiety and depressive symptoms of 148 mothers of children undergoing hemopaietic stem cell transplantation (HSCT). The roles of indicators of transplantation risk and posttransplantation medical course were also examined. Perceived partner criticism (e.g., criticizing coping efforts) and perceived partner avoidance (e.g., changing the topic), objective indicators of transplantation risk, and anxiety and depressive symptoms were assessed at the time of HSCT and again 3 and 6 months later. Growth curve modeling analyses indicated that perceived partner criticism was associated with higher average depressive symptoms. However, perceived partner criticism did not predict changes in mothers anxiety. Contrary to predictions, perceived partner avoidance was associated with decreases in maternal anxiety.

Advice to patients undergoing stem cell transplant: Content analysis of survivor peer support narratives:

BackgroundCancer survivors treated with hematopoietic stem cell transplant rely on their social network for successful recovery. However, some survivors have negative attitudes about using social resources (negative social network orientation) that are critical for their recovery.PurposeWe examined the association between survivors’ social network orientation and health-related quality of life (HRQoL) and whether it was mediated by social resources (network size, perceived support, and negative and positive support-related social exchanges).MethodsIn a longitudinal study, 255 survivors completed validated measures of social network orientation, HRQoL, and social resources. Hypotheses were tested using path analysis.ResultsMore negative social network orientation predicted worse HRQoL (p < .001). This association was partially mediated by lower perceived support and more negative social exchanges.ConclusionsSurvivors with negative social network orientation may have poorer HRQoL in part due to deficits in several key social resources. Findings highlight a subgroup at risk for poor transplant outcomes and can guide intervention development.

Helping Yourself by Offering Help: Mediators of Expressive Helping in Survivors of Hematopoietic Stem Cell Transplant

Hematopoietic stem cell transplant survivors often share advice with patients undergoing this difficult treatment. We content analyzed narratives written by 59 transplant survivors given the opportunity to share advice with patients. Analyses described categories of advice they shared and evaluated their perceptions of the helpfulness of advice they had received. We found nine advice categories and evidence for variation in their perceived helpfulness, especially for advice to “be your own advocate,” “have someone you can rely on,” and “think positive.” Findings suggest the need to investigate how seemingly innocuous advice can be unhelpful and potentially distressing to some patients.