Jane L. Henry

Posttraumatic stress disorder following cancer. A conceptual and empirical review.

Life-threatening illness has recently been recognized as a stressor that can precipitate posttraumatic stress disorder (PTSD). This development has raised questions over the extent to which the PTSD diagnosis is applicable to the psychological reaction to being diagnosed with cancer. This paper identifies the core conceptual issues pertaining to cancer-related PTSD, critically reviews the empirical literature on PTSD following cancer, and considers the possible mechanisms and course of PTSD following a diagnosis of cancer. Specific issues that need to be considered in the assessment and treatment of cancer-related PTSD are reviewed. This review highlights that there is a need for stronger empirical base to guide clinical management of PTSD in cancer patients.

Predictors of posttraumatic stress disorder following cancer.

This study investigated the predictors of posttraumatic stress disorder (PTSD) following a diagnosis of cancer. Individuals who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed within 1 month of diagnosis for acute stress disorder (ASD) and other psychological responses including depression; individuals were reassessed (N = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment ASD was diagnosed in 28% of participants, and 22% met criteria for PTSD at 6-months follow-up. Peritraumatic dissociative symptoms at the time of receiving ones cancer diagnosis was the sole predictor of PTSD severity at 6-months follow-up. Elevated dissociative symptoms and greater distress at the initial assessment were the best predictors of PTSD caseness at 6-months follow-up. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance in order to prevent chronic psychopathology.

The course of psychological disorders in the 1st year after cancer diagnosis.

This study investigated the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) and comorbid anxiety, depressive, and substance use disorders over the first 12-month period following a cancer diagnosis. Individuals recently diagnosed with 1st onset head and neck or lung malignancy were assessed for ASD within the initial month following their diagnosis and reassessed for PTSD and other psychological disorders at both 6 months and 12 months following their cancer diagnosis. The incidence for PTSD at 12 months (14%) was lower than the incidence for other anxiety (20%) and depressive (20%) disorders. This study points to the need for the development of valid therapeutic interventions to assist this population in the 1st year following their diagnosis.

A Prospective Study of Autobiographical Memory and Posttraumatic Stress Disorder Following Cancer.

In this study, the authors investigated the relationship between autobiographical memory and the onset and maintenance of distressing memories following cancer. In Study 1, participants recently diagnosed with head, neck, or lung cancer were assessed for acute stress disorder (ASD). Participants with ASD reported fewer specific memories than did participants without ASD. In Study 2, the same participants were assessed 6 months later for autobiographical memory and cancer-related posttraumatic stress disorder (PTSD). Deficits in the retrieval of specific memories in Study 1 were not predictive of subsequent PTSD. Increased hopelessness during the 6 months was associated with a decline in the retrieval of positive memories and an increase in the retrieval of negative memories. These findings accord with propositions that retrieval of distressing memories is guided by current self-image and attitude toward ones future.

The Relationship between Acute Stress Disorder and Posttraumatic Stress Disorder Following Cancer.

In this study, the authors investigated the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) following cancer diagnosis. Patients who were recently diagnosed with 1st onset head and neck or lung malignancy (N=82) were assessed for ASD within the initial month following their diagnosis and reassessed (n=63) for PTSD 6 months following their cancer diagnosis. At the initial assessment, 28% of patients had ASD, and 32% displayed subsyndromal ASD. At follow-up, PTSD was diagnosed in 53% of patients who had been diagnosed with ASD and in 11% of those who had not met criteria for ASD; 36% of patients with PTSD did not initially display ASD. In this study, the authors question the use of the ASD diagnosis to identify recently diagnosed patients at risk of PTSD.

A critical analysis of directive counselling as a component of tinnitus retraining therapy

Tinnitus retraining therapy (TRT) has been presented as a new approach to tinnitus management. In this paper a number of theoretical and practical problems with TRT are identified. These problems relate to the distinction between directive counselling and cognitive therapy, the adequacy of the cognitive therapy components, the nature of the outcome data which have been presented to date, the theoretical basis for the treatment, and the conceptual clarity of terms such as perception, attention and coping. The stated goal of removal of the perception of tinnitus may lead to confusion about the likely outcome of TRT for most patients. Methodological limitations in the research which has been published to date preclude any claims about the efficacy of TRT at the present time. It is suggested that randomized, controlled studies which include no-treatment and placebo conditions need to be undertaken. Studies are required in which the efficacy of the counselling and white noise components can be clearly isolated. Suggestions are made about the role of psychologists and non-psychologists in the provision of counselling and cognitive therapy services to tinnitus patients.

An Evaluation of Two Types of Cognitive Intervention in the Management of Chronic Tinnitus

Abstract Fifty-four subjects with chronic distressing tinnitus were randomly allocated to one of four experimental treatment conditions: (1) attention control and imagery training (AC1); (2) cognitive restructuring (CR); (3) combined attention control and imagery training plus cognitive restructuring (ACI + CR); and (4) a waiting list control (WLC). Significant overall improvements were found on measures of distress associated with tinnitus, and on a number of other measures of cognition and coping strategies. These improvements were maintained at the six-month follow-up. Relative to the WLC, the three treatment conditions (combined) were associated with improvements in tinnitus-related distress, reductions in tinnitus-related dysfunctional cognitions and an increase in the frequency of use of coping strategies. There was a significant effect in favour of the ACI group compared to the CR group on the measure of irrational beliefs. The analyses also revealed that the combined treatment condition (ACI + CR)...

Cognitive methods in the management of chronic pain and tinnitus

Abstract An overview is provided of recent contributions of cognitive theory and therapy to the understanding and management of chronic pain and tinnitus. These two disorders have several features in common, including a chronic course; low efficacy associated with conventional treatments; negative employment, interpersonal, and other consequences of the disorder; little external manifestation of the problem; and a complex set of interrelationships between perception, psychological distress, and environmental events. There has been considerable development of cognitive approaches to the understanding and management of pain, and, to a lesser extent, tinnitus. However, most of the empirical findings can be viewed as descriptions of pain-related phenomena rather than providing strong indications of causal processes. Controlled treatment-outcome studies have revealed significant effects associated with cognitive and behavioural approaches to pain, especially on measures of psychological adjustment. Most studie...

The Application of Cognitive-Behaviour Therapy to Tinnitus

Abstract The aim of this paper is to introduce clinical psychologists to the subject of tinnitus (ringing in the ears). An overview of the audiological and psychological characteristics of tinnitus is provided, followed by a guide to the interviewing and assessment of people who present with tinnitus. It is suggested that assessment should particularly focus on the content of cognitions, the emotional reactions to tinnitus, stressful life events or daily hassles, suicidal thoughts and behaviours, and sleep disturbance. The principal types of cognitive-behavioural interventions for the reduction of tinnitus-related distress are described, including cognitive restructuring, attention control and relaxation training. The outcomes obtained in controlled studies are briefly surveyed. It is concluded that cognitive-behavioural interventions have considerable promise for clients who experience severe, unrelenting tinnitus.